{"id":"F2011L02160","name":"Private Health Insurance (Benefit Requirements) Rules 2011","slug":"private-health-insurance-benefit-requirements-rules-2011","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":87597,"registerId":"commonwealth-F2011L02160-current","compilationNumber":null,"startDate":"2026-04-02","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Part 1","sectionType":"part","heading":"Preliminary","content":"## Part 1 Preliminary\n\n### 1. Name of Rules\n\nThese Rules are the Private Health Insurance (Benefit Requirements) Rules 2011.\n\n### 3. Definitions\n\nIn these Rules:\n\nAct means the Private Health Insurance Act 2007.\n\nACT means the Australian Capital Territory.\n\ncertified Type B procedure means a Type B procedure certified in accordance with clause 10 of Schedule 1.\n\ncertified overnight Type C procedure means a Type C procedure certified in accordance with clause 11 of Schedule 1.\n\ncertified Type C procedure means a Type C procedure certified in accordance with clause 7 of Schedule 3.\n\ncontinuous period of hospitalisation, for the purpose of counting days of hospital treatment, includes any two periods during which a patient was, or is, receiving hospital treatment as a patient at a hospital, whether or not the same hospital, where the periods are separated from each other by a period of not more than 7 days during which the patient was not receiving hospital treatment as a patient at any hospital.\n\ndiagnostic imaging services table means the table prescribed under subsection 4AA(1) of the Health Insurance Act 1973.\n\nfee in the MBS means the Schedule fee as defined in subsection 8(1A) of the Health Insurance Act 1973.\n\ngeneral medical services table means the table prescribed under subsection 4(1) of the Health Insurance Act 1973.\n\ninsurer means a private health insurer.\n\nitem has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.\n\nMBS comprises the:\n\n(a) general medical services table;\n\n(b) diagnostic imaging services table; and\n\n(c) pathology services table.\n\nnegotiated agreement means an agreement entered into between a hospital and an insurer, that includes provisions to the effect that, except to the extent (if any) provided in the agreement, the hospital agrees to accept payment by the insurer in satisfaction of any amount that would, apart from the agreement, be owed to the hospital, in relation to an episode of hospital treatment, by an insured person under a policy.\n\nNSW means the State of New South Wales.\n\nnursing‑home type patient has the meaning given by Schedule 4.\n\nNote: Item 19 of Schedule 2 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 also deals with nursing‑home type patients.\n\noutreach service means a service referred to in subsection 16(1) of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007, unless subsection 16(2) of that Act applies to the particular service.\n\nparticipating midwife has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.\n\npathology services table means the table prescribed under subsection 4A(1) of the Health Insurance Act 1973.\n\npolicy means a complying health insurance policy.\n\nprivate hospital means a hospital in respect of which there is in force a statement under subsection 121‑5(8) of the Act that the hospital is a private hospital.\n\nNote: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.\n\nprofessional service has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.\n\npublic hospital means a hospital in respect of which there is in force a statement under subsection 121‑5(8) of the Act that the hospital is a public hospital.\n\nNote: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.\n\nType A procedure means:\n\n(a) a procedure specified in clauses 3 to 9 of Schedule 1; or\n\n(b) a certified Type B procedure; or\n\n(c) a certified overnight Type C procedure.\n\nType B procedure means:\n\n(a) a procedure specified in clauses 3 to 7 of Schedule 3 other than a certified Type B procedure; or\n\n(b) a certified Type C procedure.\n\nType C procedure means a procedure specified in clause 8 of Schedule 3 other than a certified Type C procedure.","sortOrder":0},{"sectionNumber":"1. Name of Rules","sectionType":"division","heading":"1. Name of Rules","content":"### 1. Name of Rules\n\nThese Rules are the Private Health Insurance (Benefit Requirements) Rules 2011.","sortOrder":1},{"sectionNumber":"3. Definitions","sectionType":"division","heading":"3. Definitions","content":"### 3. Definitions\n\nIn these Rules:\n\nAct means the Private Health Insurance Act 2007.\n\nACT means the Australian Capital Territory.\n\ncertified Type B procedure means a Type B procedure certified in accordance with clause 10 of Schedule 1.\n\ncertified overnight Type C procedure means a Type C procedure certified in accordance with clause 11 of Schedule 1.\n\ncertified Type C procedure means a Type C procedure certified in accordance with clause 7 of Schedule 3.\n\ncontinuous period of hospitalisation, for the purpose of counting days of hospital treatment, includes any two periods during which a patient was, or is, receiving hospital treatment as a patient at a hospital, whether or not the same hospital, where the periods are separated from each other by a period of not more than 7 days during which the patient was not receiving hospital treatment as a patient at any hospital.\n\ndiagnostic imaging services table means the table prescribed under subsection 4AA(1) of the Health Insurance Act 1973.\n\nfee in the MBS means the Schedule fee as defined in subsection 8(1A) of the Health Insurance Act 1973.\n\ngeneral medical services table means the table prescribed under subsection 4(1) of the Health Insurance Act 1973.\n\ninsurer means a private health insurer.\n\nitem has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.\n\nMBS comprises the:\n\n(a) general medical services table;\n\n(b) diagnostic imaging services table; and\n\n(c) pathology services table.\n\nnegotiated agreement means an agreement entered into between a hospital and an insurer, that includes provisions to the effect that, except to the extent (if any) provided in the agreement, the hospital agrees to accept payment by the insurer in satisfaction of any amount that would, apart from the agreement, be owed to the hospital, in relation to an episode of hospital treatment, by an insured person under a policy.\n\nNSW means the State of New South Wales.\n\nnursing‑home type patient has the meaning given by Schedule 4.\n\nNote: Item 19 of Schedule 2 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 also deals with nursing‑home type patients.\n\noutreach service means a service referred to in subsection 16(1) of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007, unless subsection 16(2) of that Act applies to the particular service.\n\nparticipating midwife has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.\n\npathology services table means the table prescribed under subsection 4A(1) of the Health Insurance Act 1973.\n\npolicy means a complying health insurance policy.\n\nprivate hospital means a hospital in respect of which there is in force a statement under subsection 121‑5(8) of the Act that the hospital is a private hospital.\n\nNote: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.\n\nprofessional service has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.\n\npublic hospital means a hospital in respect of which there is in force a statement under subsection 121‑5(8) of the Act that the hospital is a public hospital.\n\nNote: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.\n\nType A procedure means:\n\n(a) a procedure specified in clauses 3 to 9 of Schedule 1; or\n\n(b) a certified Type B procedure; or\n\n(c) a certified overnight Type C procedure.\n\nType B procedure means:\n\n(a) a procedure specified in clauses 3 to 7 of Schedule 3 other than a certified Type B procedure; or\n\n(b) a certified Type C procedure.\n\nType C procedure means a procedure specified in clause 8 of Schedule 3 other than a certified Type C procedure.","sortOrder":2},{"sectionNumber":"Part 2","sectionType":"part","heading":"Minimum benefit requirements","content":"## Part 2 Minimum benefit requirements\n\n### 4. Psychiatric care, rehabilitation and palliative care\n\n(1) For item 1 in the table in subsection 72‑1(2) of the Act, the minimum benefit for hospital treatment specified in that item is the amount set out, or worked out using the method for working out the minimum benefit for that treatment, in Schedules 1, 2, 3 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.\n\nNote: Item 1 in the table in subsection 72‑1(2) of the Act requires that each policy that covers hospital treatment must cover any part of hospital treatment that is psychiatric care, rehabilitation or palliative care if the treatment is provided in a hospital and no medicare benefit is payable for that part of the treatment.\n\n(2) Despite subrule (1), the minimum benefit for the treatment may be reduced by the amount of any co‑payment or excess that is required to be paid under the insured person's policy in respect of that treatment.\n\n### 5. Other hospital treatments\n\n(1) For item 5 in the table in subsection 72‑1(2) of the Act, for a policy that covers any type of hospital treatment provided in a hospital, other than treatment referred to in rule 4, the minimum benefit for that treatment is the amount set out, or worked out using the method for working out the minimum benefit, for that treatment in Schedules 1, 2, 3, 4 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.\n\n(2) Despite subsection (1), if a policy covers a type of hospital treatment, other than treatment referred to in rule 4, and the insurer for that policy has a negotiated agreement with the hospital in which the treatment is provided, the minimum benefit for that treatment is the amount specified for the treatment in the negotiated agreement.\n\n(3) Despite subrules (1) and (2), the minimum benefit for the treatment may be reduced by the amount of any co‑payment or excess that is required to be paid under the insured person’s policy in respect of that treatment.\n\n### 6. Benefit not to exceed hospital fees or charges\n\n(1) In respect of treatment referred to in rule 4 and in rule 5 other than hospital treatment for a nursing‑home type patient (as set out in Schedule 4), the amount of benefit payable by the insurer in respect of hospital treatment for a person will not exceed the fees or charges incurred in respect of that hospital treatment.\n\n(2) In respect of treatment referred to in rule 5 of this Part, the amount of benefit payable by the insurer in respect of hospital treatment for a nursing‑home type patient (as set out in Schedule 4) will not exceed an amount equal to the fees or charges incurred in respect of that hospital treatment less the amount of the patient contribution in relation to the patient for each day on which the patient was a patient in the hospital.","sortOrder":3},{"sectionNumber":"4. Psychiatric care, rehabilitation and ","sectionType":"division","heading":"4. Psychiatric care, rehabilitation and palliative care","content":"### 4. Psychiatric care, rehabilitation and palliative care\n\n(1) For item 1 in the table in subsection 72‑1(2) of the Act, the minimum benefit for hospital treatment specified in that item is the amount set out, or worked out using the method for working out the minimum benefit for that treatment, in Schedules 1, 2, 3 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.\n\nNote: Item 1 in the table in subsection 72‑1(2) of the Act requires that each policy that covers hospital treatment must cover any part of hospital treatment that is psychiatric care, rehabilitation or palliative care if the treatment is provided in a hospital and no medicare benefit is payable for that part of the treatment.\n\n(2) Despite subrule (1), the minimum benefit for the treatment may be reduced by the amount of any co‑payment or excess that is required to be paid under the insured person's policy in respect of that treatment.","sortOrder":4},{"sectionNumber":"5. Other hospital treatments","sectionType":"division","heading":"5. Other hospital treatments","content":"### 5. Other hospital treatments\n\n(1) For item 5 in the table in subsection 72‑1(2) of the Act, for a policy that covers any type of hospital treatment provided in a hospital, other than treatment referred to in rule 4, the minimum benefit for that treatment is the amount set out, or worked out using the method for working out the minimum benefit, for that treatment in Schedules 1, 2, 3, 4 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.\n\n(2) Despite subsection (1), if a policy covers a type of hospital treatment, other than treatment referred to in rule 4, and the insurer for that policy has a negotiated agreement with the hospital in which the treatment is provided, the minimum benefit for that treatment is the amount specified for the treatment in the negotiated agreement.\n\n(3) Despite subrules (1) and (2), the minimum benefit for the treatment may be reduced by the amount of any co‑payment or excess that is required to be paid under the insured person’s policy in respect of that treatment.","sortOrder":5},{"sectionNumber":"6. Benefit not to exceed hospital fees o","sectionType":"division","heading":"6. Benefit not to exceed hospital fees or charges","content":"### 6. Benefit not to exceed hospital fees or charges\n\n(1) In respect of treatment referred to in rule 4 and in rule 5 other than hospital treatment for a nursing‑home type patient (as set out in Schedule 4), the amount of benefit payable by the insurer in respect of hospital treatment for a person will not exceed the fees or charges incurred in respect of that hospital treatment.\n\n(2) In respect of treatment referred to in rule 5 of this Part, the amount of benefit payable by the insurer in respect of hospital treatment for a nursing‑home type patient (as set out in Schedule 4) will not exceed an amount equal to the fees or charges incurred in respect of that hospital treatment less the amount of the patient contribution in relation to the patient for each day on which the patient was a patient in the hospital.","sortOrder":6},{"sectionNumber":"Schedule 1―Overnight accommodation: priv","sectionType":"part","heading":"Schedule 1―Overnight accommodation: private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania","content":"# Schedule 1―Overnight accommodation: private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania\n\n## Part 1 General\n\n### 1. Circumstances\n\nFor rules 4 and 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is:\n\n(a) provided to a patient who is not a nursing‑home type patient; and\n\n(b) provided to a patient:\n\n(i) at a private hospital; or\n\n(ii) as shared ward accommodation at a public hospital in Victoria or Tasmania; and\n\nNote: The definition of hospital treatment in section 121‑5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121‑5(1)(c) of the Act.\n\n(c) provided for the purpose of permitting the provision to the patient of hospital treatment that is:\n\n(i) a Type A procedure; and\n\n(ii) for a period that includes part of an overnight stay.\n\nNote: A Type A procedure is defined to include a certified Type B procedure and a certified overnight Type C procedure―see the definitions of those terms in rule 3 of Part 1 of these Rules.\n\n### 2. Minimum benefit\n\n(1) The minimum benefit for hospital treatment provided in the circumstances specified in this Schedule is the amount set out in the tables in this Schedule for that hospital treatment.\n\n(2) When counting the days referred to in the tables in this Schedule to determine the minimum benefit in respect of any particular patient, days forming part of a continuous period of hospitalisation are to be counted.\n\n```html\n

Table 1‑Overnight accommodation for private patients at private hospitals in all States/Territories

Column 1

Column 2

Class of patient

Minimum benefit payable per night

Advanced surgical patient

‑ first 14 days

$540

‑ over 14 days

$376

Surgical patient or obstetric patient

‑ first 14 days

$501

‑ over 14 days

$376

Psychiatric patient

‑ first 42 days

$501

‑ 43 – 65 days

$435

‑ over 65 days

$376

Rehabilitation patient

‑ first 49 days

$501

‑ 50 ‑ 65 days

$435

‑ over 65 days

$376

Other patients

‑ first 14 days

$435

‑ over 14 days

$376

\n```\n\n```html\n

Table 2‑Victoria‑overnight shared ward accommodation for private patients at public hospitals

Column 1

Column 2

Class of patient

Minimum benefit payable per night

Advanced surgical patient

‑ first 14 days

$540

‑ over 14 days

$376

Surgical patient or obstetric patient

‑ first 14 days

$501

‑ over 14 days

$376

Psychiatric patient

‑ first 42 days

$501

‑ 43 – 65 days

$435

‑ over 65 days

$376

Rehabilitation patient

‑ first 49 days

$501

‑ 50 ‑ 65 days

$435

‑ over 65 days

$376

Other patients

‑ first 14 days

$435

‑ over 14 days

$376

\n```\n\n```html\n

Table 3‑Tasmania‑overnight shared ward accommodation for private patients at public hospitals

Column 1

Column 2

Class of patient

Minimum benefit payable per night

Advanced surgical patient

‑ first 14 days

$540

‑ over 14 days

$376

Surgical patient or obstetric patient

‑ first 14 days

$501

‑ over 14 days

$376

Psychiatric patient

‑ first 42 days

$501

‑ 43 – 65 days

$435

‑ over 65 days

$376

Rehabilitation patient

‑ first 49 days

$501

‑ 50 ‑ 65 days

$435

‑ over 65 days

$376

Other patients

‑ first 14 days

$435

‑ over 14 days

$376

\n```\n\n## Part 2 Type A procedures\n\n### 3. Interpretation\n\nA Type A procedure is a procedure specified in this Part provided to a patient in one of the categories of patients in clauses 4 to 9.\n\n### 4. Advanced surgical patient\n\n(1) In this Schedule, advanced surgical patient has the meaning given by this clause.\n\n(2) A patient is taken to be an advanced surgical patient upon admission to a hospital:\n\n(a) from and including the day before a professional service of the type identified by the item number in the MBS which is specified in subclause (3) is rendered to the patient at that hospital, unless the particular advanced surgical procedure to be rendered is recognised as requiring a longer pre‑operative period; or\n\n(b) if a longer pre‑operative period than that referred to in paragraph (a) is required, from and including the day of admission of the patient for the purpose of providing the professional service of the type mentioned in paragraph (a); or\n\n(c) if the advanced surgery is rendered to a patient during an admission, from the day the advanced surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).\n\nNote: The effect of the reference in subclause (1)(a) to a professional service, being a service for which a Medicare benefit is payable, is that a professional service must have been provided to the patient for the minimum benefit to apply.\n\n(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS greater than $994.97:\n\n| Type A procedures: Advanced surgical patient – list of MBS items |\n| ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |\n| 30175, 30176, 30177, 30179, 30250, 30251, 30255, 30275, 30294, 30296, 30297, 30315, 30317, 30318, 30320, 30323, 30324, 30336, 30382, 30384, 30388, 30396, 30415, 30417, 30418, 30421, 30425, 30427, 30428, 30430, 30448, 30449, 30454, 30455, 30457, 30458, 30460, 30461, 30463, 30464, 30469, 30472, 30517, 30518, 30521, 30526, 30529, 30532, 30533, 30560, 30565, 30577, 30583, 30584, 30589, 30590, 30593, 30594, 30596, 30599, 30601, 30606, 30608, 30619, 30640, 30655, 30657, 30680, 30682, 30684, 30686, 30725, 30730, 30732, 30750, 30751, 30752, 30753, 30754, 30755, 30756, 30762, 30771, 30780, 30792, 30810, 31002, 31005, 31409, 31412, 31429, 31432, 31435, 31438, 31466, 31468, 31472, 31514, 31516, 31520, 31522, 31523, 31526, 31528, 31529, 31572, 31581, 31584, 32000, 32003, 32004, 32005, 32006, 32009, 32012, 32015, 32018, 32024, 32025, 32026, 32028, 32030, 32033, 32036, 32039, 32042, 32047, 32051, 32054, 32060, 32063, 32069, 32106, 32108, 32117, 32118, 32221, 32232, 32514, 32517, 32700, 32703, 32708, 32710, 32711, 32712, 32715, 32718, 32721, 32724, 32730, 32733, 32739, 32742, 32745, 32748, 32751, 32754, 32763, 33050, 33055, 33075, 33080, 33100, 33103, 33109, 33112, 33115, 33116, 33118, 33119, 33121, 33124, 33127, 33130, 33133, 33136, 33139, 33142, 33145, 33148, 33151, 33154, 33157, 33160, 33163, 33166, 33169, 33172, 33175, 33178, 33181, 33500, 33506, 33509, 33512, 33515, 33518, 33521, 33524, 33527, 33530, 33533, 33536, 33539, 33542, 33800, 33803, 33811, 33812, 33815, 33818, 33821, 33824, 33827, 33830, 33833, 33836, 33839, 33842, 34112, 34115, 34118, 34121, 34124, 34127, 34136, 34139, 34142, 34148, 34151, 34154, 34157, 34160, 34163, 34166, 34169, 34172, 34175, 34509, 34512, 34518, 34533, 34803, 34806, 34809, 34812, 34815, 34818, 34821, 34833, 35003, 35006, 35009, 35307, 35312, 35315, 35320, 35412, 35414, 35548, 35551, 35552, 35561, 35562, 35585, 35591, 35592, 35596, 35597, 35632, 35641, 35661, 35667, 35668, 35669, 35671, 35717, 35720, 35721, 35723, 35724, 35753, 35754, 35756, 36503, 36506, 36516, 36519, 36522, 36525, 36528, 36529, 36531, 36532, 36533, 36543, 36564, 36567, 36570, 36573, 36576, 36588, 36591, 36594, 36597, 36600, 36603, 36606, 36610, 36611, 36645, 36656, 37014, 37015, 37016, 37018, 37019, 37021, 37029, 37040, 37042, 37045, 37047, 37048, 37053, 37200, 37203, 37207, 37209, 37210, 37211, 37213, 37214, 37220, 37245, 37309, 37338, 37340, 37341, 37343, 37344, 37372, 37375, 37384, 37390, 37405, 37411, 37423, 37426, 37432, 37607, 37610, 37822, 37824, 37825, 37831, 37842, 37848, 37851, 38212, 38244, 38247, 38248, 38249, 38251, 38252, 38270, 38272, 38273, 38276, 38287, 38290, 38293, 38307, 38308, 38309, 38310, 38311, 38313, 38314, 38316, 38317, 38319, 38320, 38322, 38323, 38358, 38368, 38375, 38429, 38431, 38461, 38463, 38467, 38471, 38474, 38477, 38484, 38487, 38493, 38495, 38499, 38502, 38508, 38509, 38512, 38514, 38515, 38516, 38517, 38518, 38522, 38550, 38553, 38554, 38555, 38556, 38557, 38558, 38568, 38571, 38600, 38615, 38616, 38618, 38620, 38624, 38653, 38670, 38673, 38677, 38680, 38700, 38703, 38706, 38709, 38715, 38718, 38721, 38724, 38727, 38730, 38733, 38736, 38739, 38742, 38745, 38748, 38751, 38754, 38757, 38760, 38764, 38766, 38816, 38817, 38818, 38820, 38821, 38822, 38823, 38824, 38831, 38832, 38833, 38834, 38838, 38840, 38841, 38842, 38846, 38848, 38852, 38853, 38857, 38858, 38859, 38864, 39109, 39113, 39124, 39139, 39315, 39503, 39604, 39610, 39612, 39615, 39638, 39639, 39641, 39651, 39654, 39656, 39700, 39703, 39710, 39712, 39715, 39718, 39720, 39801, 39803, 39815, 39818, 39821, 39900, 39903, 40004, 40012, 40104, 40106, 40109, 40112, 40119, 40600, 40700, 40703, 40706, 40709, 40712, 40801, 40803, 40804, 40805, 40806, 40850, 40851, 40860, 41518, 41521, 41530, 41533, 41536, 41539, 41542, 41551, 41554, 41557, 41560, 41563, 41564, 41566, 41569, 41572, 41575, 41576, 41578, 41579, 41581, 41584, 41587, 41590, 41593, 41596, 41599, 41608, 41614, 41615, 41617, 41618, 41623, 41635, 41638, 41703, 41705, 41728, 41734, 41785, 41834, 41837, 41840, 41843, 41879, 41887, 41888, 41890, 42521, 42539, 42543, 42545, 42557, 42569, 42626, 42653, 42656, 42662, 42672, 42705, 42710, 42716, 42725, 42731, 42746, 42749, 42752, 42767, 42773, 42776, 42779, 42801, 42842, 42851, 42860, 43801, 43804, 43807, 43810, 43813, 43816, 43819, 43822, 43825, 43828, 43831, 43834, 43837, 43838, 43840, 43843, 43846, 43852, 43855, 43861, 43864, 43870, 43873, 43876, 43879, 43882, 43900, 43903, 43906, 43909, 43912, 43915, 43936, 43945, 43951, 43954, 43957, 43963, 43966, 43969, 43972, 43975, 43978, 43984, 43987, 43990, 43993, 43996, 44334, 44373, 45006, 45036, 45060, 45061, 45062, 45500, 45501, 45502, 45503, 45504, 45505, 45507, 45520, 45523, 45527, 45528, 45529, 45530, 45531, 45535, 45538, 45539, 45540, 45541, 45558, 45561, 45562, 45563, 45564, 45565, 45566, 45567, 45571, 45587, 45588, 45596, 45597, 45599, 45624, 45641, 45644, 45646, 45660, 45661, 45686, 45717, 45718, 45767, 45773, 45776, 45779, 45782, 45785, 45788, 45791, 45871, 45873, 45874, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088, 46090, 46104, 46105, 46106, 46107, 46108, 46109, 46110, 46111, 46112, 46116, 46117, 46118, 46119, 46120, 46121, 46122, 46123, 46124, 46128, 46129, 46133, 46134, 46135, 46136, 46150, 46151, 46152, 46153, 46154, 46155, 46156, 46157, 46158, 46159, 46160, 46161, 46170, 46171, 46172, 46173, 46174, 46175, 46176, 46177, 46178, 46179, 46180, 46181, 46182, 46183, 46184, 46185, 46315, 46318, 46321, 46324, 46325, 46380, 46393, 46394, 46395, 46477, 46504, 46507, 47486, 47489, 47491, 47501, 47511, 47519, 47531, 47534, 47558, 47566, 47588, 47591, 47956, 47983, 47984, 48254, 48421, 48422, 48426, 48427, 48433, 48446, 48448, 48450, 48452, 48512, 48918, 48919, 48921, 48924, 48939, 48942, 48951, 48954, 48958, 48959, 48960, 49106, 49115, 49116, 49117, 49210, 49230, 49306, 49318, 49319, 49321, 49372, 49374, 49376, 49378, 49380, 49382, 49384, 49386, 49388, 49390, 49392, 49394, 49396, 49398, 49512, 49516, 49517, 49518, 49519, 49521, 49524, 49525, 49527, 49530, 49533, 49536, 49542, 49544, 49548, 49551, 49554, 49564, 49565, 49592, 49594, 49712, 49715, 49716, 49717, 49740, 49742, 49744, 49763, 49764, 49765, 49766, 49767, 49768, 49769, 49770, 49776, 49778, 49779, 49780, 49781, 49784, 49785, 49786, 49787, 49788, 49789, 49790, 49797, 49798, 49814, 49815, 49836, 49838, 50212, 50215, 50218, 50221, 50224, 50233, 50236, 50239, 50245, 50300, 50303, 50306, 50321, 50324, 50336, 50351, 50354, 50372, 50378, 50384, 50394, 50395, 50399, 50411, 50414, 50417, 50420, 50423, 50450, 50451, 50455, 50456, 50460, 50461, 50465, 50466, 50470, 50471, 50475, 50476, 50592, 50604, 50608, 50612, 50620, 50624, 50628, 50632, 50636, 50640, 50644, 51011, 51012, 51013, 51014, 51015, 51021, 51022, 51023, 51024, 51025, 51026, 51031, 51032, 51033, 51034, 51035, 51036, 51041, 51042, 51043, 51044, 51045, 51051, 51052, 51053, 51054, 51055, 51056, 51057, 51058, 51059, 51061, 51062, 51063, 51064, 51065, 51066, 51071, 51072, 51073, 51102, 51103, 51130, 51131, 51160, 51165, 51170, 51171, 52123, 52126, 52129, 52158, 52337, 52342, 52345, 52348, 52351, 52354, 52357, 52360, 52363, 52366, 52369, 52372, 52375, 52379, 52380, 52382, 52430, 52446, 52821, 53209, 53212, 53221, 53224, 53227, 53230, 53233 |\n\n### 5. Obstetric patient\n\n(1) In this Schedule, obstetric patient has the meaning given by this clause.\n\n(2) A patient shall be taken to be an obstetric patient during an admission to a hospital from and including:\n\n(a) whichever is the earlier of:\n\n(i) the day on which the patient commences labour leading to delivery in that hospital; or\n\n(ii) the day on which a professional service with the item number 16406, 16515, 16518, 16519, 16522 (excluding caesarean), 16527, 16528, 16530, 16531, 16533 or 16534 is rendered to the patient in that hospital; or\n\n(b) if the circumstances in paragraph (a) do not apply, the day before a professional service with the item number 16520 and 16522 (including caesarean) is rendered to the patient at that hospital, unless the particular obstetric procedure to be rendered is recognised as requiring a longer pre‑operative period; or\n\n(c) the day on which a professional service with the item number 82118, 82120, 82123, 82125 or 82127 is rendered to a patient by a participating midwife.\n\n(3) In this clause, the item numbers specified are the item numbers in the general medical services table.\n\n### 6. Surgical patient\n\n(1) In this Schedule, surgical patient has the meaning given by this clause.\n\n(2) A patient shall be taken to be a surgical patient upon admission to a hospital from and including:\n\n(a) the day before a professional service of the type identified by the item number in the MBS which is specified in subclause (3), is rendered to the patient at that hospital, unless the particular surgical procedure to be rendered is recognised as requiring a longer pre‑operative period; or\n\n(b) if a longer pre‑operative period is required, from and including the day of admission of the patient for the purpose of providing the professional service of the type mentioned in paragraph (a); or\n\n(c) if the surgery is rendered to a patient during an admission, from the day the surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).\n\nNote: The effect of the reference in subclause (1)(a) to a professional service, being the service for which a Medicare benefit is payable, is that a professional service must have been provided to the patient for the minimum benefit to apply.\n\n(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS within the range of $296.29 to $994.97:\n\n| Type A procedures: Surgical patient – list of MBS items |\n| --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 13218, 13251, 13700, 13834, 13837, 13851, 14234, 14237, 16567, 16570, 16571, 16573, 30016, 30023, 30024, 30068, 30166, 30169, 30225, 30229, 30235, 30241, 30244, 30246, 30247, 30253, 30256, 30272, 30286, 30287, 30289, 30293, 30299, 30305, 30306, 30310, 30311, 30314, 30326, 30330, 30332, 30385, 30387, 30392, 30399, 30400, 30408, 30414, 30416, 30419, 30422, 30431, 30433, 30440, 30443, 30445, 30450, 30451, 30452, 30479, 30481, 30484, 30485, 30490, 30491, 30492, 30494, 30495, 30515, 30520, 30530, 30559, 30562, 30563, 30600, 30611, 30615, 30618, 30621, 30622, 30623, 30626, 30629, 30635, 30637, 30639, 30641, 30642, 30643, 30644, 30645, 30646, 30648, 30651, 30652, 30662, 30664, 30665, 30672, 30676, 30688, 30690, 30692, 30694, 30720, 30721, 30722, 30723, 30724, 30731, 30760, 30761, 30763, 30770, 30790, 30791, 30800, 31000, 31001, 31003, 31004, 31245, 31250, 31350, 31355, 31400, 31403, 31406, 31423, 31426, 31454, 31460, 31462, 31500, 31503, 31506, 31509, 31512, 31513, 31515, 31519, 31525, 31554, 31569, 31575, 31578, 31585, 32021, 32023, 32045, 32046, 32057, 32066, 32094, 32096, 32105, 32123, 32129, 32131, 32139, 32159, 32162, 32165, 32183, 32186, 32213, 32216, 32231, 32233, 32237, 32507, 32508, 32511, 32736, 32757, 32760, 32766, 32769, 33070, 33545, 33548, 33551, 33554, 33806, 33810, 33845, 33848, 34100, 34103, 34106, 34130, 34133, 34145, 34500, 34503, 34515, 34521, 34524, 34527, 34528, 34529, 34534, 34538, 34800, 34824, 34827, 34830, 35000, 35012, 35100, 35202, 35300, 35303, 35306, 35309, 35317, 35319, 35321, 35327, 35330, 35331, 35360, 35361, 35362, 35363, 35401, 35404, 35406, 35408, 35410, 35508, 35533, 35534, 35536, 35560, 35564, 35565, 35566, 35568, 35570, 35571, 35573, 35577, 35578, 35581, 35582, 35595, 35599, 35610, 35612, 35616, 35622, 35623, 35631, 35635, 35636, 35637, 35649, 35653, 35657, 35658, 35673, 35680, 35694, 35697, 35700, 35726, 35750, 35751, 35759, 36502, 36508, 36509, 36530, 36537, 36546, 36549, 36552, 36558, 36579, 36585, 36604, 36607, 36608, 36609, 36612, 36615, 36618, 36621, 36624, 36627, 36633, 36636, 36639, 36649, 36652, 36654, 36663, 36664, 36666, 36803, 36806, 36809, 36811, 36818, 36821, 36822, 36823, 36842, 36845, 36854, 36863, 37000, 37004, 37008, 37020, 37023, 37026, 37038, 37039, 37044, 37046, 37050, 37201, 37208, 37221, 37224, 37227, 37306, 37318, 37327, 37330, 37333, 37336, 37342, 37345, 37348, 37351, 37354, 37381, 37387, 37396, 37402, 37408, 37417, 37418, 37429, 37438, 37601, 37604, 37605, 37606, 37613, 37616, 37619, 37800, 37801, 37803, 37804, 37807, 37809, 37810, 37812, 37813, 37818, 37819, 37821, 37827, 37828, 37830, 37833, 37834, 37836, 37839, 37845, 37854, 38200, 38203, 38206, 38209, 38213, 38256, 38274, 38275, 38325, 38326, 38350, 38353, 38356, 38362, 38365, 38372, 38373, 38374, 38376, 38416, 38417, 38422, 38425, 38426, 38472, 38485, 38511, 38523, 38609, 38612, 38619, 38621, 38627, 38637, 38830, 38837, 38839, 38845, 38847, 38849, 38850, 38851, 39015, 39018, 39121, 39125, 39126, 39127, 39128, 39129, 39130, 39134, 39137, 39138, 39300, 39303, 39306, 39307, 39309, 39312, 39318, 39319, 39321, 39324, 39327, 39328, 39330, 39336, 39339, 39342, 39906, 40701, 40704, 40705, 40708, 40852, 40854, 40856, 40858, 40905, 41512, 41515, 41524, 41527, 41545, 41548, 41603, 41611, 41620, 41629, 41671, 41692, 41707, 41710, 41713, 41725, 41737, 41743, 41746, 41749, 41752, 41770, 41776, 41779, 41786, 41789, 41793, 41813, 41825, 41867, 41873, 41876, 41880, 41881, 41885, 41910, 42505, 42506, 42509, 42510, 42512, 42515, 42518, 42527, 42530, 42533, 42536, 42542, 42548, 42551, 42554, 42563, 42574, 42596, 42599, 42602, 42605, 42608, 42623, 42629, 42635, 42638, 42641, 42665, 42695, 42698, 42701, 42702, 42703, 42704, 42707, 42713, 42719, 42734, 42743, 42758, 42761, 42764, 42770, 42802, 42805, 42810, 42815, 42833, 42836, 42839, 42848, 42854, 42857, 42869, 43021, 43022, 43050, 43521, 43527, 43530, 43533, 43805, 43832, 43835, 43841, 43849, 43858, 43867, 43930, 43933, 43939, 43960, 43981, 43999, 44101, 44102, 44108, 44111, 44114, 44130, 44133, 44325, 44328, 44331, 44346, 44350, 44354, 44359, 44361, 44364, 44367, 44370, 45000, 45003, 45009, 45012, 45015, 45018, 45035, 45045, 45048, 45051, 45054, 45201, 45202, 45203, 45206, 45207, 45209, 45221, 45227, 45233, 45440, 45443, 45451, 45496, 45497, 45512, 45522, 45524, 45532, 45534, 45537, 45542, 45545, 45547, 45548, 45551, 45553, 45554, 45556, 45560, 45568, 45572, 45575, 45578, 45581, 45584, 45585, 45590, 45592, 45594, 45602, 45605, 45608, 45609, 45611, 45614, 45620, 45623, 45627, 45629, 45632, 45635, 45652, 45653, 45656, 45658, 45659, 45668, 45669, 45671, 45675, 45676, 45677, 45680, 45683, 45689, 45692, 45695, 45698, 45701, 45704, 45707, 45710, 45713, 45714, 45716, 45761, 45794, 45809, 45811, 45813, 45815, 45825, 45827, 45831, 45837, 45841, 45845, 45849, 45865, 45888, 45891, 45939, 46050, 46092, 46094, 46103, 46115, 46127, 46132, 46142, 46143, 46300, 46303, 46308, 46309, 46312, 46322, 46330, 46333, 46335, 46336, 46339, 46340, 46341, 46342, 46345, 46351, 46354, 46357, 46360, 46367, 46372, 46375, 46378, 46379, 46381, 46384, 46387, 46390, 46399, 46401, 46408, 46411, 46414, 46417, 46423, 46426, 46432, 46434, 46441, 46442, 46444, 46453, 46468, 46471, 46474, 46480, 46483, 46489, 46492, 46493, 46500, 46502, 46503, 46510, 46522, 47007, 47012, 47021, 47027, 47033, 47045, 47047, 47049, 47052, 47053, 47054, 47063, 47066, 47310, 47313, 47316, 47319, 47357, 47364, 47370, 47373, 47381, 47384, 47385, 47386, 47387, 47390, 47393, 47399, 47402, 47408, 47417, 47420, 47426, 47429, 47432, 47435, 47438, 47441, 47447, 47450, 47451, 47453, 47456, 47459, 47465, 47468, 47480, 47483, 47495, 47498, 47514, 47516, 47528, 47537, 47546, 47549, 47552, 47555, 47559, 47561, 47565, 47568, 47570, 47573, 47577, 47582, 47585, 47592, 47593, 47597, 47600, 47603, 47612, 47615, 47618, 47621, 47624, 47630, 47648, 47657, 47741, 47753, 47765, 47766, 47786, 47789, 47790, 47791, 47792, 47795, 47953, 47954, 47955, 47967, 47975, 47982, 48245, 48248, 48251, 48257, 48400, 48403, 48406, 48409, 48412, 48415, 48419, 48420, 48423, 48424, 48430, 48435, 48442, 48444, 48454, 48456, 48507, 48900, 48903, 48906, 48909, 48915, 48925, 48927, 48932, 48943, 48944, 48945, 48948, 48952, 48953, 48972, 48980, 48983, 48986, 49100, 49104, 49105, 49109, 49112, 49113, 49114, 49118, 49121, 49124, 49127, 49200, 49203, 49206, 49209, 49213, 49215, 49218, 49219, 49220, 49221, 49224, 49227, 49233, 49236, 49239, 49300, 49303, 49309, 49315, 49360, 49363, 49366, 49500, 49503, 49506, 49509, 49515, 49534, 49569, 49570, 49572, 49574, 49576, 49578, 49580, 49582, 49584, 49586, 49590, 49596, 49703, 49706, 49709, 49718, 49724, 49727, 49728, 49730, 49732, 49734, 49736, 49738, 49760, 49761, 49762, 49771, 49772, 49773, 49774, 49775, 49777, 49782, 49783, 49791, 49792, 49793, 49794, 49795, 49796, 49812, 49818, 49821, 49824, 49827, 49830, 49833, 49837, 49839, 49845, 49854, 49857, 49860, 49866, 50107, 50112, 50118, 50130, 50201, 50203, 50206, 50209, 50242, 50309, 50312, 50333, 50335, 50339, 50345, 50357, 50360, 50369, 50375, 50381, 50393, 50396, 50426, 50428, 50508, 50512, 50524, 50528, 50532, 50536, 50540, 50544, 50548, 50552, 50556, 50560, 50564, 50568, 50572, 50576, 50580, 50584, 50588, 50596, 50600, 50616, 50654, 50950, 50952, 51020, 51110, 51111, 51114, 51115, 51140, 51141, 51145, 51150, 51900, 51904, 51906, 52018, 52035, 52048, 52051, 52054, 52059, 52063, 52066, 52078, 52090, 52092, 52094, 52095, 52105, 52108, 52111, 52114, 52117, 52120, 52122, 52130, 52131, 52138, 52141, 52144, 52147, 52148, 52182, 52184, 52186, 52300, 52303, 52306, 52312, 52315, 52324, 52330, 52333, 52336, 52339, 52378, 52424, 52440, 52442, 52444, 52450, 52452, 52456, 52458, 52460, 52480, 52482, 52484, 52600, 52603, 52609, 52612, 52615, 52618, 52621, 52624, 52626, 52627, 52633, 52800, 52803, 52806, 52809, 52812, 52815, 52818, 52824, 52828, 52830, 52832, 53015, 53016, 53017, 53019, 53215, 53220, 53226, 53236, 53239, 53242, 53406, 53409, 53412, 53413, 53414, 53415, 53416, 53418, 53419, 53422, 53423, 53424, 53425, 53427, 53429, 53453, 53455, 53460 |\n\n### 7. Psychiatric patient\n\nIn this Schedule, a psychiatric patient is a patient in a hospital who is admitted for the purposes of undertaking a specific psychiatric treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient’s disease, injury or condition.\n\nNote: If a patient is receiving psychiatric treatment that is not under a specific psychiatric treatment program, the patient is taken to be in the category of 'other patient'.\n\n### 8. Rehabilitation patient\n\nIn this Schedule, a rehabilitation patient is a patient in a hospital who is admitted for the purposes of undertaking a specific rehabilitation treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient’s disease, injury or condition.\n\nNote: If a patient is receiving rehabilitation treatment that is not under a specific rehabilitation treatment program, the patient is taken to be in the category of 'other patient'.\n\n### 9. Other patient\n\n(1) In this Schedule, other patient is deemed to be a patient at a hospital who is receiving any treatment that involves part of an overnight stay, but who is not:\n\n(a) an advanced surgical patient;\n\n(b) a surgical patient;\n\n(c) an obstetric patient;\n\n(d) a psychiatric patient; or\n\n(e) a rehabilitation patient.\n\nNote: A patient receiving hospital treatment that is palliative care as described in item 1 of the table in subsection 72‑1(2) of the Act is deemed to be in the category of 'other patient'.","sortOrder":7},{"sectionNumber":"1. Circumstances","sectionType":"division","heading":"1. Circumstances","content":"### 1. Circumstances\n\nFor rules 4 and 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is:\n\n(a) provided to a patient who is not a nursing‑home type patient; and\n\n(b) provided to a patient:\n\n(i) at a private hospital; or\n\n(ii) as shared ward accommodation at a public hospital in Victoria or Tasmania; and\n\nNote: The definition of hospital treatment in section 121‑5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121‑5(1)(c) of the Act.\n\n(c) provided for the purpose of permitting the provision to the patient of hospital treatment that is:\n\n(i) a Type A procedure; and\n\n(ii) for a period that includes part of an overnight stay.\n\nNote: A Type A procedure is defined to include a certified Type B procedure and a certified overnight Type C procedure―see the definitions of those terms in rule 3 of Part 1 of these Rules.","sortOrder":9},{"sectionNumber":"2. Minimum benefit","sectionType":"division","heading":"2. Minimum benefit","content":"### 2. Minimum benefit\n\n(1) The minimum benefit for hospital treatment provided in the circumstances specified in this Schedule is the amount set out in the tables in this Schedule for that hospital treatment.\n\n(2) When counting the days referred to in the tables in this Schedule to determine the minimum benefit in respect of any particular patient, days forming part of a continuous period of hospitalisation are to be counted.\n\n```html\n

Table 1‑Overnight accommodation for private patients at private hospitals in all States/Territories

Column 1

Column 2

Class of patient

Minimum benefit payable per night

Advanced surgical patient

‑ first 14 days

$540

‑ over 14 days

$376

Surgical patient or obstetric patient

‑ first 14 days

$501

‑ over 14 days

$376

Psychiatric patient

‑ first 42 days

$501

‑ 43 – 65 days

$435

‑ over 65 days

$376

Rehabilitation patient

‑ first 49 days

$501

‑ 50 ‑ 65 days

$435

‑ over 65 days

$376

Other patients

‑ first 14 days

$435

‑ over 14 days

$376

\n```\n\n```html\n

Table 2‑Victoria‑overnight shared ward accommodation for private patients at public hospitals

Column 1

Column 2

Class of patient

Minimum benefit payable per night

Advanced surgical patient

‑ first 14 days

$540

‑ over 14 days

$376

Surgical patient or obstetric patient

‑ first 14 days

$501

‑ over 14 days

$376

Psychiatric patient

‑ first 42 days

$501

‑ 43 – 65 days

$435

‑ over 65 days

$376

Rehabilitation patient

‑ first 49 days

$501

‑ 50 ‑ 65 days

$435

‑ over 65 days

$376

Other patients

‑ first 14 days

$435

‑ over 14 days

$376

\n```\n\n```html\n

Table 3‑Tasmania‑overnight shared ward accommodation for private patients at public hospitals

Column 1

Column 2

Class of patient

Minimum benefit payable per night

Advanced surgical patient

‑ first 14 days

$540

‑ over 14 days

$376

Surgical patient or obstetric patient

‑ first 14 days

$501

‑ over 14 days

$376

Psychiatric patient

‑ first 42 days

$501

‑ 43 – 65 days

$435

‑ over 65 days

$376

Rehabilitation patient

‑ first 49 days

$501

‑ 50 ‑ 65 days

$435

‑ over 65 days

$376

Other patients

‑ first 14 days

$435

‑ over 14 days

$376

\n```","sortOrder":10},{"sectionNumber":"3. Interpretation","sectionType":"division","heading":"3. Interpretation","content":"### 3. Interpretation\n\nA Type A procedure is a procedure specified in this Part provided to a patient in one of the categories of patients in clauses 4 to 9.","sortOrder":12},{"sectionNumber":"4. Advanced surgical patient","sectionType":"division","heading":"4. Advanced surgical patient","content":"### 4. Advanced surgical patient\n\n(1) In this Schedule, advanced surgical patient has the meaning given by this clause.\n\n(2) A patient is taken to be an advanced surgical patient upon admission to a hospital:\n\n(a) from and including the day before a professional service of the type identified by the item number in the MBS which is specified in subclause (3) is rendered to the patient at that hospital, unless the particular advanced surgical procedure to be rendered is recognised as requiring a longer pre‑operative period; or\n\n(b) if a longer pre‑operative period than that referred to in paragraph (a) is required, from and including the day of admission of the patient for the purpose of providing the professional service of the type mentioned in paragraph (a); or\n\n(c) if the advanced surgery is rendered to a patient during an admission, from the day the advanced surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).\n\nNote: The effect of the reference in subclause (1)(a) to a professional service, being a service for which a Medicare benefit is payable, is that a professional service must have been provided to the patient for the minimum benefit to apply.\n\n(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS greater than $994.97:\n\n| Type A procedures: Advanced surgical patient – list of MBS items |\n| ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |\n| 30175, 30176, 30177, 30179, 30250, 30251, 30255, 30275, 30294, 30296, 30297, 30315, 30317, 30318, 30320, 30323, 30324, 30336, 30382, 30384, 30388, 30396, 30415, 30417, 30418, 30421, 30425, 30427, 30428, 30430, 30448, 30449, 30454, 30455, 30457, 30458, 30460, 30461, 30463, 30464, 30469, 30472, 30517, 30518, 30521, 30526, 30529, 30532, 30533, 30560, 30565, 30577, 30583, 30584, 30589, 30590, 30593, 30594, 30596, 30599, 30601, 30606, 30608, 30619, 30640, 30655, 30657, 30680, 30682, 30684, 30686, 30725, 30730, 30732, 30750, 30751, 30752, 30753, 30754, 30755, 30756, 30762, 30771, 30780, 30792, 30810, 31002, 31005, 31409, 31412, 31429, 31432, 31435, 31438, 31466, 31468, 31472, 31514, 31516, 31520, 31522, 31523, 31526, 31528, 31529, 31572, 31581, 31584, 32000, 32003, 32004, 32005, 32006, 32009, 32012, 32015, 32018, 32024, 32025, 32026, 32028, 32030, 32033, 32036, 32039, 32042, 32047, 32051, 32054, 32060, 32063, 32069, 32106, 32108, 32117, 32118, 32221, 32232, 32514, 32517, 32700, 32703, 32708, 32710, 32711, 32712, 32715, 32718, 32721, 32724, 32730, 32733, 32739, 32742, 32745, 32748, 32751, 32754, 32763, 33050, 33055, 33075, 33080, 33100, 33103, 33109, 33112, 33115, 33116, 33118, 33119, 33121, 33124, 33127, 33130, 33133, 33136, 33139, 33142, 33145, 33148, 33151, 33154, 33157, 33160, 33163, 33166, 33169, 33172, 33175, 33178, 33181, 33500, 33506, 33509, 33512, 33515, 33518, 33521, 33524, 33527, 33530, 33533, 33536, 33539, 33542, 33800, 33803, 33811, 33812, 33815, 33818, 33821, 33824, 33827, 33830, 33833, 33836, 33839, 33842, 34112, 34115, 34118, 34121, 34124, 34127, 34136, 34139, 34142, 34148, 34151, 34154, 34157, 34160, 34163, 34166, 34169, 34172, 34175, 34509, 34512, 34518, 34533, 34803, 34806, 34809, 34812, 34815, 34818, 34821, 34833, 35003, 35006, 35009, 35307, 35312, 35315, 35320, 35412, 35414, 35548, 35551, 35552, 35561, 35562, 35585, 35591, 35592, 35596, 35597, 35632, 35641, 35661, 35667, 35668, 35669, 35671, 35717, 35720, 35721, 35723, 35724, 35753, 35754, 35756, 36503, 36506, 36516, 36519, 36522, 36525, 36528, 36529, 36531, 36532, 36533, 36543, 36564, 36567, 36570, 36573, 36576, 36588, 36591, 36594, 36597, 36600, 36603, 36606, 36610, 36611, 36645, 36656, 37014, 37015, 37016, 37018, 37019, 37021, 37029, 37040, 37042, 37045, 37047, 37048, 37053, 37200, 37203, 37207, 37209, 37210, 37211, 37213, 37214, 37220, 37245, 37309, 37338, 37340, 37341, 37343, 37344, 37372, 37375, 37384, 37390, 37405, 37411, 37423, 37426, 37432, 37607, 37610, 37822, 37824, 37825, 37831, 37842, 37848, 37851, 38212, 38244, 38247, 38248, 38249, 38251, 38252, 38270, 38272, 38273, 38276, 38287, 38290, 38293, 38307, 38308, 38309, 38310, 38311, 38313, 38314, 38316, 38317, 38319, 38320, 38322, 38323, 38358, 38368, 38375, 38429, 38431, 38461, 38463, 38467, 38471, 38474, 38477, 38484, 38487, 38493, 38495, 38499, 38502, 38508, 38509, 38512, 38514, 38515, 38516, 38517, 38518, 38522, 38550, 38553, 38554, 38555, 38556, 38557, 38558, 38568, 38571, 38600, 38615, 38616, 38618, 38620, 38624, 38653, 38670, 38673, 38677, 38680, 38700, 38703, 38706, 38709, 38715, 38718, 38721, 38724, 38727, 38730, 38733, 38736, 38739, 38742, 38745, 38748, 38751, 38754, 38757, 38760, 38764, 38766, 38816, 38817, 38818, 38820, 38821, 38822, 38823, 38824, 38831, 38832, 38833, 38834, 38838, 38840, 38841, 38842, 38846, 38848, 38852, 38853, 38857, 38858, 38859, 38864, 39109, 39113, 39124, 39139, 39315, 39503, 39604, 39610, 39612, 39615, 39638, 39639, 39641, 39651, 39654, 39656, 39700, 39703, 39710, 39712, 39715, 39718, 39720, 39801, 39803, 39815, 39818, 39821, 39900, 39903, 40004, 40012, 40104, 40106, 40109, 40112, 40119, 40600, 40700, 40703, 40706, 40709, 40712, 40801, 40803, 40804, 40805, 40806, 40850, 40851, 40860, 41518, 41521, 41530, 41533, 41536, 41539, 41542, 41551, 41554, 41557, 41560, 41563, 41564, 41566, 41569, 41572, 41575, 41576, 41578, 41579, 41581, 41584, 41587, 41590, 41593, 41596, 41599, 41608, 41614, 41615, 41617, 41618, 41623, 41635, 41638, 41703, 41705, 41728, 41734, 41785, 41834, 41837, 41840, 41843, 41879, 41887, 41888, 41890, 42521, 42539, 42543, 42545, 42557, 42569, 42626, 42653, 42656, 42662, 42672, 42705, 42710, 42716, 42725, 42731, 42746, 42749, 42752, 42767, 42773, 42776, 42779, 42801, 42842, 42851, 42860, 43801, 43804, 43807, 43810, 43813, 43816, 43819, 43822, 43825, 43828, 43831, 43834, 43837, 43838, 43840, 43843, 43846, 43852, 43855, 43861, 43864, 43870, 43873, 43876, 43879, 43882, 43900, 43903, 43906, 43909, 43912, 43915, 43936, 43945, 43951, 43954, 43957, 43963, 43966, 43969, 43972, 43975, 43978, 43984, 43987, 43990, 43993, 43996, 44334, 44373, 45006, 45036, 45060, 45061, 45062, 45500, 45501, 45502, 45503, 45504, 45505, 45507, 45520, 45523, 45527, 45528, 45529, 45530, 45531, 45535, 45538, 45539, 45540, 45541, 45558, 45561, 45562, 45563, 45564, 45565, 45566, 45567, 45571, 45587, 45588, 45596, 45597, 45599, 45624, 45641, 45644, 45646, 45660, 45661, 45686, 45717, 45718, 45767, 45773, 45776, 45779, 45782, 45785, 45788, 45791, 45871, 45873, 45874, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088, 46090, 46104, 46105, 46106, 46107, 46108, 46109, 46110, 46111, 46112, 46116, 46117, 46118, 46119, 46120, 46121, 46122, 46123, 46124, 46128, 46129, 46133, 46134, 46135, 46136, 46150, 46151, 46152, 46153, 46154, 46155, 46156, 46157, 46158, 46159, 46160, 46161, 46170, 46171, 46172, 46173, 46174, 46175, 46176, 46177, 46178, 46179, 46180, 46181, 46182, 46183, 46184, 46185, 46315, 46318, 46321, 46324, 46325, 46380, 46393, 46394, 46395, 46477, 46504, 46507, 47486, 47489, 47491, 47501, 47511, 47519, 47531, 47534, 47558, 47566, 47588, 47591, 47956, 47983, 47984, 48254, 48421, 48422, 48426, 48427, 48433, 48446, 48448, 48450, 48452, 48512, 48918, 48919, 48921, 48924, 48939, 48942, 48951, 48954, 48958, 48959, 48960, 49106, 49115, 49116, 49117, 49210, 49230, 49306, 49318, 49319, 49321, 49372, 49374, 49376, 49378, 49380, 49382, 49384, 49386, 49388, 49390, 49392, 49394, 49396, 49398, 49512, 49516, 49517, 49518, 49519, 49521, 49524, 49525, 49527, 49530, 49533, 49536, 49542, 49544, 49548, 49551, 49554, 49564, 49565, 49592, 49594, 49712, 49715, 49716, 49717, 49740, 49742, 49744, 49763, 49764, 49765, 49766, 49767, 49768, 49769, 49770, 49776, 49778, 49779, 49780, 49781, 49784, 49785, 49786, 49787, 49788, 49789, 49790, 49797, 49798, 49814, 49815, 49836, 49838, 50212, 50215, 50218, 50221, 50224, 50233, 50236, 50239, 50245, 50300, 50303, 50306, 50321, 50324, 50336, 50351, 50354, 50372, 50378, 50384, 50394, 50395, 50399, 50411, 50414, 50417, 50420, 50423, 50450, 50451, 50455, 50456, 50460, 50461, 50465, 50466, 50470, 50471, 50475, 50476, 50592, 50604, 50608, 50612, 50620, 50624, 50628, 50632, 50636, 50640, 50644, 51011, 51012, 51013, 51014, 51015, 51021, 51022, 51023, 51024, 51025, 51026, 51031, 51032, 51033, 51034, 51035, 51036, 51041, 51042, 51043, 51044, 51045, 51051, 51052, 51053, 51054, 51055, 51056, 51057, 51058, 51059, 51061, 51062, 51063, 51064, 51065, 51066, 51071, 51072, 51073, 51102, 51103, 51130, 51131, 51160, 51165, 51170, 51171, 52123, 52126, 52129, 52158, 52337, 52342, 52345, 52348, 52351, 52354, 52357, 52360, 52363, 52366, 52369, 52372, 52375, 52379, 52380, 52382, 52430, 52446, 52821, 53209, 53212, 53221, 53224, 53227, 53230, 53233 |","sortOrder":13},{"sectionNumber":"5. Obstetric patient","sectionType":"division","heading":"5. Obstetric patient","content":"### 5. Obstetric patient\n\n(1) In this Schedule, obstetric patient has the meaning given by this clause.\n\n(2) A patient shall be taken to be an obstetric patient during an admission to a hospital from and including:\n\n(a) whichever is the earlier of:\n\n(i) the day on which the patient commences labour leading to delivery in that hospital; or\n\n(ii) the day on which a professional service with the item number 16406, 16515, 16518, 16519, 16522 (excluding caesarean), 16527, 16528, 16530, 16531, 16533 or 16534 is rendered to the patient in that hospital; or\n\n(b) if the circumstances in paragraph (a) do not apply, the day before a professional service with the item number 16520 and 16522 (including caesarean) is rendered to the patient at that hospital, unless the particular obstetric procedure to be rendered is recognised as requiring a longer pre‑operative period; or\n\n(c) the day on which a professional service with the item number 82118, 82120, 82123, 82125 or 82127 is rendered to a patient by a participating midwife.\n\n(3) In this clause, the item numbers specified are the item numbers in the general medical services table.","sortOrder":14},{"sectionNumber":"6. Surgical patient","sectionType":"division","heading":"6. Surgical patient","content":"### 6. Surgical patient\n\n(1) In this Schedule, surgical patient has the meaning given by this clause.\n\n(2) A patient shall be taken to be a surgical patient upon admission to a hospital from and including:\n\n(a) the day before a professional service of the type identified by the item number in the MBS which is specified in subclause (3), is rendered to the patient at that hospital, unless the particular surgical procedure to be rendered is recognised as requiring a longer pre‑operative period; or\n\n(b) if a longer pre‑operative period is required, from and including the day of admission of the patient for the purpose of providing the professional service of the type mentioned in paragraph (a); or\n\n(c) if the surgery is rendered to a patient during an admission, from the day the surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).\n\nNote: The effect of the reference in subclause (1)(a) to a professional service, being the service for which a Medicare benefit is payable, is that a professional service must have been provided to the patient for the minimum benefit to apply.\n\n(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS within the range of $296.29 to $994.97:\n\n| Type A procedures: Surgical patient – list of MBS items |\n| --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 13218, 13251, 13700, 13834, 13837, 13851, 14234, 14237, 16567, 16570, 16571, 16573, 30016, 30023, 30024, 30068, 30166, 30169, 30225, 30229, 30235, 30241, 30244, 30246, 30247, 30253, 30256, 30272, 30286, 30287, 30289, 30293, 30299, 30305, 30306, 30310, 30311, 30314, 30326, 30330, 30332, 30385, 30387, 30392, 30399, 30400, 30408, 30414, 30416, 30419, 30422, 30431, 30433, 30440, 30443, 30445, 30450, 30451, 30452, 30479, 30481, 30484, 30485, 30490, 30491, 30492, 30494, 30495, 30515, 30520, 30530, 30559, 30562, 30563, 30600, 30611, 30615, 30618, 30621, 30622, 30623, 30626, 30629, 30635, 30637, 30639, 30641, 30642, 30643, 30644, 30645, 30646, 30648, 30651, 30652, 30662, 30664, 30665, 30672, 30676, 30688, 30690, 30692, 30694, 30720, 30721, 30722, 30723, 30724, 30731, 30760, 30761, 30763, 30770, 30790, 30791, 30800, 31000, 31001, 31003, 31004, 31245, 31250, 31350, 31355, 31400, 31403, 31406, 31423, 31426, 31454, 31460, 31462, 31500, 31503, 31506, 31509, 31512, 31513, 31515, 31519, 31525, 31554, 31569, 31575, 31578, 31585, 32021, 32023, 32045, 32046, 32057, 32066, 32094, 32096, 32105, 32123, 32129, 32131, 32139, 32159, 32162, 32165, 32183, 32186, 32213, 32216, 32231, 32233, 32237, 32507, 32508, 32511, 32736, 32757, 32760, 32766, 32769, 33070, 33545, 33548, 33551, 33554, 33806, 33810, 33845, 33848, 34100, 34103, 34106, 34130, 34133, 34145, 34500, 34503, 34515, 34521, 34524, 34527, 34528, 34529, 34534, 34538, 34800, 34824, 34827, 34830, 35000, 35012, 35100, 35202, 35300, 35303, 35306, 35309, 35317, 35319, 35321, 35327, 35330, 35331, 35360, 35361, 35362, 35363, 35401, 35404, 35406, 35408, 35410, 35508, 35533, 35534, 35536, 35560, 35564, 35565, 35566, 35568, 35570, 35571, 35573, 35577, 35578, 35581, 35582, 35595, 35599, 35610, 35612, 35616, 35622, 35623, 35631, 35635, 35636, 35637, 35649, 35653, 35657, 35658, 35673, 35680, 35694, 35697, 35700, 35726, 35750, 35751, 35759, 36502, 36508, 36509, 36530, 36537, 36546, 36549, 36552, 36558, 36579, 36585, 36604, 36607, 36608, 36609, 36612, 36615, 36618, 36621, 36624, 36627, 36633, 36636, 36639, 36649, 36652, 36654, 36663, 36664, 36666, 36803, 36806, 36809, 36811, 36818, 36821, 36822, 36823, 36842, 36845, 36854, 36863, 37000, 37004, 37008, 37020, 37023, 37026, 37038, 37039, 37044, 37046, 37050, 37201, 37208, 37221, 37224, 37227, 37306, 37318, 37327, 37330, 37333, 37336, 37342, 37345, 37348, 37351, 37354, 37381, 37387, 37396, 37402, 37408, 37417, 37418, 37429, 37438, 37601, 37604, 37605, 37606, 37613, 37616, 37619, 37800, 37801, 37803, 37804, 37807, 37809, 37810, 37812, 37813, 37818, 37819, 37821, 37827, 37828, 37830, 37833, 37834, 37836, 37839, 37845, 37854, 38200, 38203, 38206, 38209, 38213, 38256, 38274, 38275, 38325, 38326, 38350, 38353, 38356, 38362, 38365, 38372, 38373, 38374, 38376, 38416, 38417, 38422, 38425, 38426, 38472, 38485, 38511, 38523, 38609, 38612, 38619, 38621, 38627, 38637, 38830, 38837, 38839, 38845, 38847, 38849, 38850, 38851, 39015, 39018, 39121, 39125, 39126, 39127, 39128, 39129, 39130, 39134, 39137, 39138, 39300, 39303, 39306, 39307, 39309, 39312, 39318, 39319, 39321, 39324, 39327, 39328, 39330, 39336, 39339, 39342, 39906, 40701, 40704, 40705, 40708, 40852, 40854, 40856, 40858, 40905, 41512, 41515, 41524, 41527, 41545, 41548, 41603, 41611, 41620, 41629, 41671, 41692, 41707, 41710, 41713, 41725, 41737, 41743, 41746, 41749, 41752, 41770, 41776, 41779, 41786, 41789, 41793, 41813, 41825, 41867, 41873, 41876, 41880, 41881, 41885, 41910, 42505, 42506, 42509, 42510, 42512, 42515, 42518, 42527, 42530, 42533, 42536, 42542, 42548, 42551, 42554, 42563, 42574, 42596, 42599, 42602, 42605, 42608, 42623, 42629, 42635, 42638, 42641, 42665, 42695, 42698, 42701, 42702, 42703, 42704, 42707, 42713, 42719, 42734, 42743, 42758, 42761, 42764, 42770, 42802, 42805, 42810, 42815, 42833, 42836, 42839, 42848, 42854, 42857, 42869, 43021, 43022, 43050, 43521, 43527, 43530, 43533, 43805, 43832, 43835, 43841, 43849, 43858, 43867, 43930, 43933, 43939, 43960, 43981, 43999, 44101, 44102, 44108, 44111, 44114, 44130, 44133, 44325, 44328, 44331, 44346, 44350, 44354, 44359, 44361, 44364, 44367, 44370, 45000, 45003, 45009, 45012, 45015, 45018, 45035, 45045, 45048, 45051, 45054, 45201, 45202, 45203, 45206, 45207, 45209, 45221, 45227, 45233, 45440, 45443, 45451, 45496, 45497, 45512, 45522, 45524, 45532, 45534, 45537, 45542, 45545, 45547, 45548, 45551, 45553, 45554, 45556, 45560, 45568, 45572, 45575, 45578, 45581, 45584, 45585, 45590, 45592, 45594, 45602, 45605, 45608, 45609, 45611, 45614, 45620, 45623, 45627, 45629, 45632, 45635, 45652, 45653, 45656, 45658, 45659, 45668, 45669, 45671, 45675, 45676, 45677, 45680, 45683, 45689, 45692, 45695, 45698, 45701, 45704, 45707, 45710, 45713, 45714, 45716, 45761, 45794, 45809, 45811, 45813, 45815, 45825, 45827, 45831, 45837, 45841, 45845, 45849, 45865, 45888, 45891, 45939, 46050, 46092, 46094, 46103, 46115, 46127, 46132, 46142, 46143, 46300, 46303, 46308, 46309, 46312, 46322, 46330, 46333, 46335, 46336, 46339, 46340, 46341, 46342, 46345, 46351, 46354, 46357, 46360, 46367, 46372, 46375, 46378, 46379, 46381, 46384, 46387, 46390, 46399, 46401, 46408, 46411, 46414, 46417, 46423, 46426, 46432, 46434, 46441, 46442, 46444, 46453, 46468, 46471, 46474, 46480, 46483, 46489, 46492, 46493, 46500, 46502, 46503, 46510, 46522, 47007, 47012, 47021, 47027, 47033, 47045, 47047, 47049, 47052, 47053, 47054, 47063, 47066, 47310, 47313, 47316, 47319, 47357, 47364, 47370, 47373, 47381, 47384, 47385, 47386, 47387, 47390, 47393, 47399, 47402, 47408, 47417, 47420, 47426, 47429, 47432, 47435, 47438, 47441, 47447, 47450, 47451, 47453, 47456, 47459, 47465, 47468, 47480, 47483, 47495, 47498, 47514, 47516, 47528, 47537, 47546, 47549, 47552, 47555, 47559, 47561, 47565, 47568, 47570, 47573, 47577, 47582, 47585, 47592, 47593, 47597, 47600, 47603, 47612, 47615, 47618, 47621, 47624, 47630, 47648, 47657, 47741, 47753, 47765, 47766, 47786, 47789, 47790, 47791, 47792, 47795, 47953, 47954, 47955, 47967, 47975, 47982, 48245, 48248, 48251, 48257, 48400, 48403, 48406, 48409, 48412, 48415, 48419, 48420, 48423, 48424, 48430, 48435, 48442, 48444, 48454, 48456, 48507, 48900, 48903, 48906, 48909, 48915, 48925, 48927, 48932, 48943, 48944, 48945, 48948, 48952, 48953, 48972, 48980, 48983, 48986, 49100, 49104, 49105, 49109, 49112, 49113, 49114, 49118, 49121, 49124, 49127, 49200, 49203, 49206, 49209, 49213, 49215, 49218, 49219, 49220, 49221, 49224, 49227, 49233, 49236, 49239, 49300, 49303, 49309, 49315, 49360, 49363, 49366, 49500, 49503, 49506, 49509, 49515, 49534, 49569, 49570, 49572, 49574, 49576, 49578, 49580, 49582, 49584, 49586, 49590, 49596, 49703, 49706, 49709, 49718, 49724, 49727, 49728, 49730, 49732, 49734, 49736, 49738, 49760, 49761, 49762, 49771, 49772, 49773, 49774, 49775, 49777, 49782, 49783, 49791, 49792, 49793, 49794, 49795, 49796, 49812, 49818, 49821, 49824, 49827, 49830, 49833, 49837, 49839, 49845, 49854, 49857, 49860, 49866, 50107, 50112, 50118, 50130, 50201, 50203, 50206, 50209, 50242, 50309, 50312, 50333, 50335, 50339, 50345, 50357, 50360, 50369, 50375, 50381, 50393, 50396, 50426, 50428, 50508, 50512, 50524, 50528, 50532, 50536, 50540, 50544, 50548, 50552, 50556, 50560, 50564, 50568, 50572, 50576, 50580, 50584, 50588, 50596, 50600, 50616, 50654, 50950, 50952, 51020, 51110, 51111, 51114, 51115, 51140, 51141, 51145, 51150, 51900, 51904, 51906, 52018, 52035, 52048, 52051, 52054, 52059, 52063, 52066, 52078, 52090, 52092, 52094, 52095, 52105, 52108, 52111, 52114, 52117, 52120, 52122, 52130, 52131, 52138, 52141, 52144, 52147, 52148, 52182, 52184, 52186, 52300, 52303, 52306, 52312, 52315, 52324, 52330, 52333, 52336, 52339, 52378, 52424, 52440, 52442, 52444, 52450, 52452, 52456, 52458, 52460, 52480, 52482, 52484, 52600, 52603, 52609, 52612, 52615, 52618, 52621, 52624, 52626, 52627, 52633, 52800, 52803, 52806, 52809, 52812, 52815, 52818, 52824, 52828, 52830, 52832, 53015, 53016, 53017, 53019, 53215, 53220, 53226, 53236, 53239, 53242, 53406, 53409, 53412, 53413, 53414, 53415, 53416, 53418, 53419, 53422, 53423, 53424, 53425, 53427, 53429, 53453, 53455, 53460 |","sortOrder":15},{"sectionNumber":"7. Psychiatric patient","sectionType":"division","heading":"7. Psychiatric patient","content":"### 7. Psychiatric patient\n\nIn this Schedule, a psychiatric patient is a patient in a hospital who is admitted for the purposes of undertaking a specific psychiatric treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient’s disease, injury or condition.\n\nNote: If a patient is receiving psychiatric treatment that is not under a specific psychiatric treatment program, the patient is taken to be in the category of 'other patient'.","sortOrder":16},{"sectionNumber":"8. Rehabilitation patient","sectionType":"division","heading":"8. Rehabilitation patient","content":"### 8. Rehabilitation patient\n\nIn this Schedule, a rehabilitation patient is a patient in a hospital who is admitted for the purposes of undertaking a specific rehabilitation treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient’s disease, injury or condition.\n\nNote: If a patient is receiving rehabilitation treatment that is not under a specific rehabilitation treatment program, the patient is taken to be in the category of 'other patient'.","sortOrder":17},{"sectionNumber":"9. Other patient","sectionType":"division","heading":"9. Other patient","content":"### 9. Other patient\n\n(1) In this Schedule, other patient is deemed to be a patient at a hospital who is receiving any treatment that involves part of an overnight stay, but who is not:\n\n(a) an advanced surgical patient;\n\n(b) a surgical patient;\n\n(c) an obstetric patient;\n\n(d) a psychiatric patient; or\n\n(e) a rehabilitation patient.\n\nNote: A patient receiving hospital treatment that is palliative care as described in item 1 of the table in subsection 72‑1(2) of the Act is deemed to be in the category of 'other patient'.","sortOrder":18},{"sectionNumber":"Part 3","sectionType":"part","heading":"Certified Type B procedures and certified overnight Type C procedures","content":"## Part 3 Certified Type B procedures and certified overnight Type C procedures\n\n### 10. Certified Type B procedures\n\n(1) Minimum benefits for overnight accommodation are payable for patients receiving a Type B procedure only if certification under subclause (2) is provided.\n\n(2) Certification must be provided as follows:\n\n(a) the practitioner providing the Type B procedure; or\n\n(b) a professional employed by a hospital who is involved in the provision of the procedure provided by that hospital,\n\nmust certify in writing that:\n\n(c) because of the medical condition of the patient specified in the certificate; or\n\n(d) because of the special circumstances specified in the certificate,\n\nit would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at the hospital for a period that includes part of an overnight stay.\n\n### 11. Certified overnight Type C procedures\n\n(1) Minimum benefits for overnight accommodation are payable for patients receiving a certified Type C procedure only if:\n\n(a) certification has first been provided for the Type C procedure in accordance with clause 7 of Schedule 3; and\n\n(b) certification under subclause (2) is also provided.\n\n(2) Certification must be provided as follows the practitioner providing the certified Type C procedure must certify in writing that:\n\n(a) because of the medical condition of the patient specified in the certificate; or\n\n(b) because of the special circumstances specified in the certificate,\n\nit would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at the hospital for a period that includes part of an overnight stay.","sortOrder":19},{"sectionNumber":"10. Certified Type B procedures","sectionType":"division","heading":"10. Certified Type B procedures","content":"### 10. Certified Type B procedures\n\n(1) Minimum benefits for overnight accommodation are payable for patients receiving a Type B procedure only if certification under subclause (2) is provided.\n\n(2) Certification must be provided as follows:\n\n(a) the practitioner providing the Type B procedure; or\n\n(b) a professional employed by a hospital who is involved in the provision of the procedure provided by that hospital,\n\nmust certify in writing that:\n\n(c) because of the medical condition of the patient specified in the certificate; or\n\n(d) because of the special circumstances specified in the certificate,\n\nit would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at the hospital for a period that includes part of an overnight stay.","sortOrder":20},{"sectionNumber":"11. Certified overnight Type C procedure","sectionType":"division","heading":"11. Certified overnight Type C procedures","content":"### 11. Certified overnight Type C procedures\n\n(1) Minimum benefits for overnight accommodation are payable for patients receiving a certified Type C procedure only if:\n\n(a) certification has first been provided for the Type C procedure in accordance with clause 7 of Schedule 3; and\n\n(b) certification under subclause (2) is also provided.\n\n(2) Certification must be provided as follows the practitioner providing the certified Type C procedure must certify in writing that:\n\n(a) because of the medical condition of the patient specified in the certificate; or\n\n(b) because of the special circumstances specified in the certificate,\n\nit would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at the hospital for a period that includes part of an overnight stay.","sortOrder":21},{"sectionNumber":"Schedule 2 ‑ Overnight shared ward accom","sectionType":"part","heading":"Schedule 2 ‑ Overnight shared ward accommodation for private patients at public hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia","content":"# Schedule 2 ‑ Overnight shared ward accommodation for private patients at public hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia\n\n### 1. Circumstances\n\nFor rules 4 and 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is provided:\n\n(a) to a patient who is not a nursing‑home type patient; and\n\n(b) as shared ward accommodation at a public hospital in the ACT, NSW, Northern Territory, Queensland, South Australia or Western Australia; and\n\nNote: The definition of hospital treatment in section 121‑5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121‑5(1)(c) of the Act.\n\n(c) for the purpose of permitting the provision to the patient of hospital treatment that is:\n\n(i) a Type A procedure; and\n\n(ii) for a period that includes part of an overnight stay.\n\nNote: A Type A procedure is defined to include a certified Type B procedure and a certified overnight Type C procedure―see the definitions of those terms in rule 3 of Part 1 of these Rules.\n\n### 2. Minimum benefit\n\nThe minimum benefit for hospital treatment provided in the circumstances described in this Schedule is the amount set out in the table in this Schedule for that hospital treatment.\n\n```html\n

Table 1‑Overnight shared ward accommodation for private patients at public hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia

Column 1

Column 2

State/Territory

Minimum benefit payable per night

Australian Capital Territory

$446

New South Wales

$446

Northern Territory

$446

Queensland

$458

South Australia

$446

Western Australia

$446

\n```","sortOrder":22},{"sectionNumber":"Schedule 3―Same‑day accommodation: hospi","sectionType":"part","heading":"Schedule 3―Same‑day accommodation: hospitals in all States/Territories","content":"# Schedule 3―Same‑day accommodation: hospitals in all States/Territories\n\n## Part 1 General\n\n### 1. Circumstances\n\nFor rules 4 and 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is provided for the purpose of permitting the provision to the patient of hospital treatment that:\n\n(a) is a Type B procedure; and\n\n(b) is provided to a patient at a hospital; and\n\n(c) does not include part of an overnight stay at a hospital.\n\nNote 1: A Type B procedure includes a certified Type C procedure―see the definitions of those terms in rule 3 of Part 1 of these Rules.\n\nNote 2: The definition of hospital treatment in section 121‑5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121‑5 (1) (c) of the Act.\n\n### 2. Minimum benefit\n\n(1) The minimum benefit for hospital treatment provided in the circumstances specified in this Schedule is the amount set out in Table 1 or 2 in this clause for that hospital treatment.\n\n(2) The references to Bands in the tables are references as follows:\n\n(a) Band 1 means Band 1 treatment;\n\n(b) Band 2 means Band 2 treatment;\n\n(c) Band 3 means Band 3 treatment;\n\n(d) Band 4 means Band 4 treatment,\n\nas those bands are described in Part 2 of this Schedule.\n\n```html\n

Table 1‑Same day accommodation for private patients at public hospitals in all States/Territories

Column 1

Column 2

Column 3

Column 4

Column 5

Public hospitals

Band 1

Band 2

Band 3

Band 4

New South Wales

$324

$360

$398

$446

Australian Capital Territory

$324

$360

$398

$446

Northern Territory

$324

$372

$428

$446

Queensland

$330

$374

$409

$458

South Australia

$324

$372

$408

$446

Tasmania

$314

$375

$432

$501

Victoria

$318

$376

$436

$501

Western Australia

$368

$368

$368

$368

\n```\n\n```html\n

Table 2‑ Same day accommodation for private patients at private hospitals in all States/Territories

Column 1

Column 2

Column 3

Column 4

Column 5

Private hospitals

Band 1

Band 2

Band 3

Band 4

All States and Territories

$281

$352

$428

$501

\n```","sortOrder":25},{"sectionNumber":"4. Band 1","sectionType":"division","heading":"4. Band 1","content":"### 4. Band 1\n\n(1) Hospital treatment that involves a professional service of the type identified by the MBS item number specified in the following table in this clause is Band 1 treatment for the purposes of the tables in clause 2 of this Schedule:\n\n| Type B day procedures: Band 1 – list of MBS items |\n| ---------------------------------------------------------------------------------- |\n| 13100, 13103, 13706, 13950, 30210, 32215, 36665, 39000, 41674, 42575, 55600, 55603 |\n\n(2) Other hospital treatment requiring day admission to a hospital that is not Band 2, 3 or 4 treatment is Band 1 treatment for the purposes of the tables in clause 2 of this Schedule.","sortOrder":31},{"sectionNumber":"5. Non‑band specific Type B day procedur","sectionType":"division","heading":"5. Non‑band specific Type B day procedures","content":"### 5. Non‑band specific Type B day procedures\n\n(1) Hospital treatment that involves a professional service of the type identified by the MBS item number specified in the following table in this clause is a non‑band specific Type B day procedure:\n\n| Non‑band specific Type B day procedures – list of MBS items |\n| -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 111, 117, 120, 11801, 11919, 13110, 13212, 13215, 13241, 13318, 13400, 13750, 13755, 13757, 13761, 13762, 13815, 14218, 14224, 14247, 14249, 16512, 16603, 16618, 18216, 18230, 18242, 18276, 18280, 18284, 18286, 18290, 18294, 18296, 18298, 18375, 18379, 30042, 30045, 30055, 30081, 30084, 30087, 30094, 30099, 30103, 30104, 30107, 30187, 30189, 30190, 30223, 30257, 30262, 30269, 30281, 30283, 30390, 30409, 30473, 30475, 30478, 30627, 30630, 30658, 30661, 30679, 30687, 30820, 31225, 31227, 31344, 31345, 31346, 31356, 31357, 31358, 31359, 31360, 31361, 31363, 31364, 31367, 31369, 31370, 31371, 31372, 31373, 31374, 31375, 31376, 31377, 31378, 31379, 31380, 31381, 31382, 31383, 31386, 31387, 31388, 31456, 31458, 31530, 31551, 31557, 31560, 31563, 31566, 31590, 32075, 32095, 32147, 32150, 32156, 32171, 32218, 32222, 32223, 32224, 32225, 32226, 32227, 32228, 32229, 32230, 32235, 32236, 32504, 34109, 34506, 34539, 35324, 35500, 35507, 35509, 35513, 35517, 35539, 35545, 35557, 35569, 35630, 35633, 35640, 35643, 35644, 35645, 35647, 35648, 35730, 36504, 36505, 36507, 36561, 36650, 36667, 36668, 36812, 36815, 36824, 36827, 36830, 36833, 36836, 36840, 36860, 37011, 37215, 37216, 37217, 37218, 37219, 37226, 37321, 37324, 37339, 37369, 37435, 37623, 37806, 37815, 37816, 38285, 38286, 38288, 38419, 38420, 38428, 39013, 39014, 39100, 39110, 39111, 39116, 39117, 39118, 39119, 39133, 39135, 39140, 39323, 39329, 39331, 39332, 39345, 40702, 41503, 41506, 41509, 41626, 41632, 41644, 41650, 41677, 41693, 41701, 41702, 41722, 41801, 41822, 41831, 41855, 41861, 41870, 41886, 42503, 42504, 42572, 42573, 42576, 42584, 42590, 42610, 42611, 42632, 42647, 42652, 42673, 42680, 42683, 42686, 42689, 42692, 42750, 42812, 42818, 42845, 42863, 42866, 42872, 43030, 43032, 43034, 43036, 43038, 43040, 43942, 43948, 44104, 44105, 44136, 44338, 44342, 44358, 44376, 45019, 45027, 45030, 45033, 45200, 45212, 45224, 45239, 45510, 45515, 45589, 45626, 45665, 45674, 45823, 45851, 45855, 45857, 46101, 46102, 46113, 46114, 46125, 46126, 46130, 46131, 46140, 46141, 46348, 46363, 46364, 46365, 46370, 46420, 46438, 46450, 46486, 46495, 46501, 46525, 47738, 47906, 47915, 47918, 47927, 48436, 48438, 48440, 49803, 49806, 49809, 49881, 49884, 49887, 49890, 50115, 50352, 51112, 51113, 51120, 51902, 52015, 52025, 52042, 52045, 52057, 52058, 52061, 52062, 52064, 52072, 52073, 52075, 52081, 52084, 52087, 52097, 52099, 52102, 52180, 52321, 52826, 53003, 53006, 53009, 53054, 53056, 53058, 53060, 53062, 53064, 53070, 53206, 53218, 53225, 53410, 53459, 55118, 58939, 59970, 60000, 60003, 60006, 60009, 60012, 60015, 60018, 60021, 60024, 60027, 60030, 60033, 60036, 60039, 60042, 60045, 60048, 60051, 60054, 60057, 60060, 60063, 60066, 60069, 60072, 60075, 60078, 60500, 71202, 73310, 73313, 73316, 73425, 73426 |\n\n(2) A non‑band specific Type B day procedure is Band 2, 3 or 4 treatment depending on anaesthetic type and, where applicable, theatre time as specified in clause 6 of this Schedule.\n\n(3) If a non‑band specific Type B day procedure does not involve anaesthetic or theatre times, the minimum benefit is the benefit for Band 1 treatment.","sortOrder":32},{"sectionNumber":"6. Other bands","sectionType":"division","heading":"6. Other bands","content":"### 6. Other bands\n\n(1) In this Schedule:\n\nBand 2 treatment means procedures, other than those that are Band 1 treatment, carried out under local anaesthetic with no sedation.\n\nBand 3 treatment means procedures, other than those that are Band 1 treatment, carried out under:\n\n(a) general anaesthesia; or\n\n(b) regional anaesthesia; or\n\n(c) intravenous sedation,\n\nwhere the theatre time, being the actual time in theatre, is less than one hour.\n\nBand 4 treatment means procedures, other than those that are Band 1 treatment, carried out under:\n\n(a) general anaesthesia; or\n\n(b) regional anaesthesia; or\n\n(c) intravenous sedation,\n\nwhere the theatre time, being the actual time in theatre, is one hour or more.","sortOrder":33},{"sectionNumber":"7. Certified Type C procedure","sectionType":"division","heading":"7. Certified Type C procedure","content":"### 7. Certified Type C procedure\n\nNote: Type C procedures are procedures that do not normally require hospital treatment.\n\n(1) Benefits for day‑only accommodation are payable for patients receiving a Type C procedure only if certification under subclause (2) is provided.\n\n(2) Certification must be provided as follows, the medical practitioner providing the professional service must certify in writing that:\n\n(a) because of the medical condition of the patient specified in the certificate; or\n\n(b) because of the special circumstances specified in the certificate,\n\nit would be contrary to accepted medical practice to provide the procedure to the patient unless the patient is given hospital treatment at the hospital for a period that does not include part of an overnight stay.","sortOrder":34},{"sectionNumber":"8. Interpretation","sectionType":"division","heading":"8. Interpretation","content":"### 8. Interpretation\n\nA Type C procedure is a procedure specified in this clause by reference to MBS items in the following table:\n\nNote: These procedures normally do not require hospital treatment.\n\n| Type C procedures – list of MBS items |\n| ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n| 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 104, 105, 106, 107, 108, 109, 110, 115, 116, 119, 122, 127, 128, 129, 131, 132, 133, 135, 137, 139, 141, 143, 145, 147, 160, 161, 162, 163, 164, 170, 171, 172, 193, 195, 197, 199, 235, 236, 237, 238, 239, 240, 285, 287, 289, 291, 293, 299, 341, 342, 343, 344, 345, 346, 347, 349, 385, 386, 387, 388, 392, 393, 410, 411, 412, 413, 414, 415, 416, 417, 729, 731, 735, 739, 743, 747, 750, 758, 820, 822, 823, 825, 826, 828, 855, 857, 858, 900, 903, 930, 933, 935, 937, 943, 945, 946, 948, 959, 961, 962, 964, 965, 969, 971, 972, 973, 975, 986, 2721, 2723, 2725, 2727, 2801, 2806, 2814, 2824, 2832, 2840, 2946, 2949, 2954, 2958, 2972, 2974, 3005, 3010, 3014, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 4001, 5000, 5001, 5003, 5004, 5010, 5011, 5012, 5013, 5014, 5016, 5017, 5019, 5020, 5021, 5022, 5023, 5027, 5028, 5030, 5031, 5032, 5033, 5035, 5036, 5039, 5040, 5041, 5042, 5043, 5044, 5049, 5060, 5063, 5067, 5200, 5203, 5207, 5208, 5220, 5223, 5227, 5228, 5260, 5263, 5265, 5267, 6007, 6009, 6011, 6013, 6015, 6018, 6019, 6023, 6024, 6028, 6029, 6031, 6032, 6034, 6035, 6037, 6038, 6042, 6051, 6052, 6057, 6058, 6062, 6063, 6064, 6065, 6067, 6068, 6071, 6072, 6074, 6075, 6080, 6081, 6082, 6084, 10801, 10802, 10803, 10804, 10805, 10806, 10807, 10808, 10809, 10816, 10988, 10989, 11000, 11003, 11012, 11015, 11018, 11024, 11027, 11200, 11204, 11205, 11210, 11211, 11215, 11218, 11219, 11220, 11221, 11224, 11235, 11237, 11240, 11241, 11242, 11243, 11244, 11300, 11302, 11306, 11309, 11312, 11315, 11318, 11324, 11332, 11340, 11341, 11343, 11503, 11505, 11506, 11507, 11508, 11512, 11602, 11604, 11605, 11607, 11610, 11611, 11612, 11614, 11615, 11705, 11713, 11719, 11720, 11721, 11724, 11725, 11726, 11727, 11728, 11729, 11730, 11731, 11732, 11736, 11737, 11800, 11810, 11820, 11823, 11830, 11833, 11900, 11912, 11917, 12000, 12001, 12002, 12003, 12004, 12005, 12012, 12017, 12021, 12022, 12024, 12200, 12201, 12306, 12312, 12315, 12320, 12321, 12322, 12325, 12326, 12500, 12524, 12527, 12533, 13104, 13200, 13203, 13207, 13209, 13221, 13260, 13290, 13312, 13839, 14050, 14100, 14106, 14115, 14118, 14124, 14201, 14202, 14203, 14206, 14216, 14217, 14219, 14220, 14221, 14227, 14245, 14255, 14256, 14257, 14258, 14259, 14260, 14263, 14264, 14265, 14266, 14270, 14272, 14277, 14278, 14280, 14283, 14285, 14288, 15902, 15904, 15906, 15908, 15910, 15912, 15914, 15916, 15918, 15920, 15922, 15924, 15926, 15928, 15930, 15932, 15934, 15936, 15938, 15940, 15942, 15944, 15946, 15948, 15950, 15952, 15954, 15956, 15958, 15960, 15962, 15964, 15966, 15968, 15970, 15972, 15974, 15976, 15978, 15980, 15982, 15984, 15990, 16003, 16006, 16009, 16012, 16015, 16018, 16400, 16407, 16408, 16500, 16509, 16511, 16514, 16600, 17610, 17615, 17620, 17625, 17640, 17645, 17650, 17655, 17690, 18213, 18350, 18351, 18353, 18354, 18355, 18360, 18361, 18362, 18365, 18366, 18368, 18369, 18370, 18372, 18374, 18377, 30003, 30006, 30007, 30026, 30032, 30038, 30061, 30062, 30064, 30071, 30072, 30097, 30191, 30192, 30196, 30202, 30207, 30216, 30219, 30278, 30406, 30628, 30654, 31206, 31211, 31216, 31220, 31221, 31362, 31365, 31366, 31368, 31537, 31587, 32072, 32135, 32500, 32520, 32522, 32523, 32526, 32528, 32529, 35503, 35554, 35608, 35614, 35620, 35626, 35703, 36671, 36672, 36673, 36800, 37041, 37300, 37303, 37388, 37415, 38800, 39141, 40707, 40862, 40863, 41500, 41501, 41647, 41659, 41662, 41764, 41768, 41769, 42587, 42588, 42614, 42615, 42617, 42620, 42644, 42650, 42667, 42668, 42676, 42677, 42744, 42794, 42808, 42811, 45021, 45025, 45546, 45801, 45807, 45829, 45882, 47471, 47735, 47904, 47916, 47924, 50310, 51700, 51703, 52034, 52036, 52055, 52056, 52133, 53000, 53004, 53052, 53458, 55028, 55029, 55030, 55031, 55032, 55033, 55036, 55037, 55038, 55039, 55048, 55049, 55054, 55065, 55066, 55068, 55070, 55071, 55073, 55076, 55079, 55080, 55126, 55127, 55128, 55129, 55132, 55133, 55134, 55137, 55141, 55143, 55145, 55146, 55238, 55244, 55246, 55248, 55252, 55274, 55276, 55278, 55280, 55282, 55284, 55292, 55294, 55296, 55700, 55703, 55704, 55705, 55706, 55707, 55708, 55709, 55712, 55715, 55718, 55721, 55723, 55725, 55729, 55736, 55739, 55740, 55741, 55742, 55743, 55757, 55758, 55812, 55814, 55844, 55846, 55852, 55854, 55856, 55857, 55858, 55859, 55860, 55861, 55862, 55863, 55864, 55865, 55866, 55867, 55868, 55869, 55870, 55871, 55872, 55873, 55874, 55875, 55876, 55877, 55878, 55879, 55880, 55881, 55882, 55883, 55884, 55885, 55886, 55887, 55888, 55889, 55890, 55891, 55892, 55893, 55894, 55895, 56001, 56007, 56010, 56013, 56016, 56022, 56028, 56030, 56036, 56101, 56107, 56220, 56221, 56223, 56224, 56225, 56226, 56233, 56234, 56237, 56238, 56301, 56307, 56401, 56407, 56409, 56412, 56501, 56507, 56553, 56620, 56622, 56623, 56626, 56627, 56628, 56629, 56630, 56801, 56807, 57001, 57007, 57201, 57341, 57352, 57353, 57354, 57357, 57360, 57364, 57410, 57413, 57506, 57509, 57512, 57515, 57518, 57521, 57522, 57523, 57524, 57527, 57700, 57703, 57706, 57709, 57712, 57715, 57721, 57901, 57902, 57905, 57907, 57915, 57918, 57921, 57924, 57927, 57930, 57933, 57939, 57942, 57945, 57960, 57963, 57966, 57969, 58100, 58103, 58106, 58108, 58109, 58112, 58115, 58300, 58306, 58500, 58503, 58506, 58509, 58521, 58524, 58527, 58700, 58706, 58715, 58718, 58721, 58900, 58903, 58909, 58912, 58915, 58916, 58921, 58927, 58933, 58936, 59103, 59300, 59302, 59303, 59305, 59312, 59314, 59318, 59700, 59703, 59712, 59718, 59724, 59733, 59739, 59751, 59754, 59763, 60503, 60918, 60927, 61310, 61313, 61314, 61321, 61324, 61325, 61328, 61329, 61333, 61336, 61340, 61341, 61345, 61348, 61349, 61353, 61356, 61357, 61360, 61361, 61364, 61368, 61372, 61373, 61376, 61381, 61383, 61384, 61386, 61387, 61389, 61390, 61393, 61394, 61397, 61398, 61402, 61406, 61409, 61410, 61413, 61414, 61421, 61425, 61426, 61429, 61430, 61433, 61434, 61438, 61441, 61442, 61445, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 61466, 61469, 61473, 61480, 61485, 61495, 61499, 61505, 61524, 61527, 61528, 61530, 61541, 61553, 61560, 61563, 61564, 61565, 61612, 61614, 61644, 61647, 63001, 63004, 63007, 63010, 63019, 63020, 63040, 63043, 63046, 63049, 63052, 63055, 63058, 63061, 63064, 63067, 63070, 63073, 63101, 63111, 63114, 63125, 63128, 63131, 63151, 63154, 63161, 63164, 63167, 63170, 63173, 63176, 63179, 63182, 63185, 63201, 63204, 63219, 63222, 63225, 63228, 63231, 63234, 63237, 63240, 63243, 63271, 63274, 63277, 63280, 63301, 63304, 63307, 63322, 63325, 63328, 63331, 63334, 63337, 63340, 63361, 63385, 63388, 63390, 63391, 63395, 63397, 63401, 63404, 63416, 63425, 63428, 63440, 63443, 63446, 63454, 63461, 63464, 63467, 63470, 63473, 63476, 63482, 63487, 63489, 63491, 63494, 63496, 63497, 63507, 63510, 63513, 63516, 63519, 63522, 63531, 63533, 63539, 63540, 63541, 63543, 63545, 63546, 63547, 63549, 63551, 63554, 63557, 63560, 63563, 63564, 63740, 63741, 63743, 65060, 65066, 65070, 65072, 65075, 65078, 65079, 65081, 65082, 65084, 65087, 65090, 65093, 65096, 65099, 65102, 65105, 65108, 65109, 65110, 65111, 65114, 65117, 65120, 65123, 65126, 65129, 65137, 65142, 65144, 65147, 65150, 65153, 65156, 65157, 65158, 65159, 65162, 65165, 65166, 65171, 65175, 65176, 65177, 65178, 65179, 65180, 65181, 66500, 66503, 66506, 66509, 66512, 66517, 66518, 66519, 66520, 66522, 66523, 66525, 66536, 66539, 66542, 66545, 66548, 66551, 66554, 66557, 66560, 66563, 66566, 66569, 66572, 66575, 66578, 66581, 66584, 66585, 66586, 66587, 66590, 66593, 66596, 66605, 66606, 66607, 66623, 66626, 66629, 66632, 66635, 66638, 66639, 66641, 66642, 66644, 66647, 66650, 66651, 66652, 66653, 66654, 66655, 66656, 66659, 66660, 66662, 66663, 66665, 66666, 66667, 66671, 66674, 66677, 66680, 66683, 66686, 66695, 66696, 66697, 66698, 66701, 66704, 66707, 66711, 66712, 66714, 66715, 66716, 66719, 66722, 66723, 66724, 66725, 66728, 66731, 66734, 66743, 66749, 66750, 66751, 66752, 66755, 66756, 66757, 66758, 66761, 66764, 66767, 66770, 66773, 66776, 66779, 66780, 66782, 66783, 66785, 66788, 66789, 66790, 66791, 66792, 66800, 66803, 66804, 66805, 66806, 66812, 66815, 66816, 66817, 66819, 66820, 66821, 66822, 66825, 66826, 66827, 66828, 66829, 66830, 66831, 66832, 66833, 66834, 66835, 66836, 66837, 66838, 66839, 66840, 66841, 66842, 66900, 69300, 69303, 69306, 69309, 69312, 69316, 69317, 69318, 69319, 69321, 69324, 69325, 69327, 69328, 69330, 69331, 69333, 69336, 69339, 69345, 69354, 69357, 69360, 69363, 69379, 69383, 69384, 69387, 69390, 69393, 69396, 69400, 69401, 69405, 69408, 69411, 69413, 69415, 69421, 69422, 69445, 69451, 69471, 69472, 69474, 69475, 69478, 69481, 69482, 69483, 69484, 69488, 69489, 69491, 69492, 69494, 69495, 69496, 69497, 69498, 69499, 69500, 69505, 71057, 71058, 71059, 71060, 71062, 71064, 71066, 71068, 71069, 71071, 71072, 71073, 71074, 71075, 71076, 71077, 71079, 71081, 71083, 71085, 71087, 71089, 71090, 71091, 71092, 71093, 71095, 71096, 71097, 71099, 71101, 71103, 71106, 71119, 71121, 71123, 71125, 71127, 71129, 71131, 71133, 71134, 71135, 71137, 71139, 71141, 71143, 71145, 71146, 71147, 71148, 71149, 71151, 71153, 71154, 71155, 71156, 71157, 71159, 71163, 71164, 71165, 71166, 71167, 71168, 71169, 71170, 71175, 71180, 71183, 71186, 71189, 71192, 71195, 71198, 71200, 71203, 72813, 72814, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836, 72838, 72844, 72846, 72847, 72848, 72849, 72850, 72851, 72852, 72855, 72856, 72857, 73043, 73045, 73047, 73049, 73051, 73059, 73060, 73061, 73062, 73063, 73064, 73065, 73070, 73071, 73072, 73074, 73075, 73076, 73287, 73289, 73290, 73291, 73292, 73293, 73294, 73295, 73296, 73297, 73298, 73299, 73300, 73304, 73305, 73306, 73308, 73309, 73311, 73312, 73314, 73315, 73317, 73318, 73320, 73321, 73322, 73323, 73324, 73332, 73333, 73334, 73335, 73336, 73337, 73338, 73339, 73340, 73341, 73342, 73343, 73344, 73345, 73346, 73347, 73348, 73349, 73350, 73351, 73352, 73353, 73354, 73355, 73356, 73357, 73358, 73359, 73360, 73361, 73362, 73363, 73364, 73365, 73366, 73367, 73368, 73369, 73370, 73371, 73372, 73373, 73374, 73375, 73376, 73377, 73378, 73379, 73380, 73381, 73382, 73383, 73384, 73385, 73386, 73387, 73388, 73389, 73391, 73392, 73393, 73394, 73395, 73396, 73397, 73398, 73399, 73401, 73402, 73403, 73404, 73405, 73406, 73410, 73411, 73412, 73413, 73416, 73417, 73418, 73419, 73420, 73421, 73422, 73423, 73424, 73427, 73428, 73429, 73430, 73431, 73432, 73433, 73434, 73435, 73436, 73437, 73438, 73439, 73440, 73441, 73442, 73443, 73444, 73445, 73446, 73447, 73448, 73451, 73452, 73453, 73454, 73455, 73456, 73457, 73458, 73459, 73460, 73461, 73462, 73521, 73523, 73525, 73527, 73529, 73801, 73802, 73803, 73804, 73805, 73806, 73807, 73808, 73809, 73810, 73811, 73812, 73813, 73825, 73826, 73920, 73922, 73923, 73924, 73925, 73926, 73927, 73928, 73929, 73930, 73931, 73932, 73933, 73934, 73935, 73936, 73937, 73938, 73939, 73940, 74992, 74993, 74994, 74995, 74996, 74997, 74998, 74999, 82100, 82102, 82104, 82105, 82110, 82115, 82116, 82130, 82135, 82140, 82203, 82226, 82227, 82228, 91868, 91869, 91870, 91871, 91872, 91873, 91874, 91875, 91876, 91877, 91878, 91879, 91880, 91881, 91882, 91883, 91884 |","sortOrder":36},{"sectionNumber":"Schedule 4―Nursing‑home type patient acc","sectionType":"part","heading":"Schedule 4―Nursing‑home type patient accommodation: hospitals in all States/Territories","content":"# Schedule 4―Nursing‑home type patient accommodation: hospitals in all States/Territories\n\n### 1. Circumstances\n\n(1) For rule 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is provided:\n\n(a) to a nursing‑home type patient; and\n\n(b) at a hospital.\n\nNote: The definition of hospital treatment in section 121‑5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121‑5(1)(c) of the Act.\n\n### 2. Interpretation\n\nNursing‑home type patient, in relation to a hospital, means a patient who has been provided with hospital treatment whether:\n\n(a) acute care; or\n\n(b) accommodation and nursing care, as an end in itself; or\n\n(c) a mixture of both,\n\nfor a continuous period of hospitalisation exceeding 35 days (35‑day period), but a patient receiving acute care immediately after the 35‑day period does not become a nursing‑home type patient unless the period of acute care ends and the patient is then provided with accommodation and nursing care, as an end in itself, as part of a continuous period of hospitalisation.\n\nNote 1: 'Continuous period of hospitalisation' is defined in rule 3 of Part 1 of these Rules.\n\nNote 2: Clause 4 deals with nursing‑home type patients whose care needs change to requiring acute care.\n\nNote 3: If there is disagreement as to whether a patient is, or is not, a nursing‑home type patient, an insured person, a private health insurer or a health care provider may make a complaint to the Private Health Insurance Ombudsman under Part 6‑2 of the Act. The Ombudsman has various powers to deal with complaints, including conducting mediation if the complainant agrees.\n\n### 3. Application\n\n(1) Clause 2 of this Schedule applies to a patient who on or after the day on which the Private Health Insurance (Benefit Requirements) Amendment Rules 2007 (No. 4) commence:\n\n(a) returns to hospital for hospital treatment at a hospital not later than 7 days after receiving hospital treatment at that hospital or another hospital; or\n\n(b) is otherwise admitted to a hospital for hospital treatment at the hospital.\n\n(2) If subclause (1) does not apply to a patient, the definition of 'nursing‑home type patient' in these Rules before the commencement of the Private Health Insurance (Benefit Requirements) Amendment Rules 2007 (No. 4) continues to apply to that patient.\n\nNote: Clause 4 deals with nursing‑home type patients whose care needs change to requiring acute care.\n\n### 4. Provision of acute care\n\nIf a nursing‑home type patient is provided with acute care at the hospital (the first hospital), or at another hospital, the patient:\n\n(a) ceases to be a nursing‑home type patient only for the days on which the acute care is provided; and\n\n(b) again becomes a nursing‑home type patient when the provision of acute care ends and the patient is then provided with accommodation and nursing care as an end in itself, whether at the first hospital or another hospital.\n\n### 5. Ceasing and resuming hospital treatment\n\nIf a nursing‑home type patient, or a person referred to in paragraph 4(a), leaves hospital but returns to a hospital, whether or not at the same hospital, not more than 7 days later and is provided with hospital treatment at the hospital, the patient is a nursing‑home type patient for each subsequent day that the patient is provided with accommodation and nursing care, as an end in itself, until the patient ceases to be provided with hospital treatment at a hospital for a period of more than 7 days.\n\nNote: If the relevant period of hospitalisation is broken by more than 7 days, clause 2 of this Schedule may again apply to the person.\n\n### 6. Minimum benefit\n\nThe minimum benefit for hospital treatment provided in the circumstances described in this Schedule is the amount set out in Table 1 or 2 of this Schedule for that hospital treatment.\n\n#### Table 1\n\n| Public hospital: State/Territory | Minimum benefit per night |\n| -------------------------------- | ------------------------- |\n| Australian Capital Territory | $152.25 |\n| New South Wales | $190.30 |\n| Northern Territory | $162.75 |\n| Queensland | $150.75 |\n| South Australia | $150.00 |\n| Tasmania | $194.27 |\n| Victoria | $166.72 |\n| Western Australia | $155.15 |\n\n#### Table 2\n\n| Private hospitals | $30.15 |\n| ----------------- | ------ |","sortOrder":37},{"sectionNumber":"2. Interpretation","sectionType":"division","heading":"2. Interpretation","content":"### 2. Interpretation\n\nNursing‑home type patient, in relation to a hospital, means a patient who has been provided with hospital treatment whether:\n\n(a) acute care; or\n\n(b) accommodation and nursing care, as an end in itself; or\n\n(c) a mixture of both,\n\nfor a continuous period of hospitalisation exceeding 35 days (35‑day period), but a patient receiving acute care immediately after the 35‑day period does not become a nursing‑home type patient unless the period of acute care ends and the patient is then provided with accommodation and nursing care, as an end in itself, as part of a continuous period of hospitalisation.\n\nNote 1: 'Continuous period of hospitalisation' is defined in rule 3 of Part 1 of these Rules.\n\nNote 2: Clause 4 deals with nursing‑home type patients whose care needs change to requiring acute care.\n\nNote 3: If there is disagreement as to whether a patient is, or is not, a nursing‑home type patient, an insured person, a private health insurer or a health care provider may make a complaint to the Private Health Insurance Ombudsman under Part 6‑2 of the Act. The Ombudsman has various powers to deal with complaints, including conducting mediation if the complainant agrees.","sortOrder":39},{"sectionNumber":"3. Application","sectionType":"division","heading":"3. Application","content":"### 3. Application\n\n(1) Clause 2 of this Schedule applies to a patient who on or after the day on which the Private Health Insurance (Benefit Requirements) Amendment Rules 2007 (No. 4) commence:\n\n(a) returns to hospital for hospital treatment at a hospital not later than 7 days after receiving hospital treatment at that hospital or another hospital; or\n\n(b) is otherwise admitted to a hospital for hospital treatment at the hospital.\n\n(2) If subclause (1) does not apply to a patient, the definition of 'nursing‑home type patient' in these Rules before the commencement of the Private Health Insurance (Benefit Requirements) Amendment Rules 2007 (No. 4) continues to apply to that patient.\n\nNote: Clause 4 deals with nursing‑home type patients whose care needs change to requiring acute care.","sortOrder":40},{"sectionNumber":"4. Provision of acute care","sectionType":"division","heading":"4. Provision of acute care","content":"### 4. Provision of acute care\n\nIf a nursing‑home type patient is provided with acute care at the hospital (the first hospital), or at another hospital, the patient:\n\n(a) ceases to be a nursing‑home type patient only for the days on which the acute care is provided; and\n\n(b) again becomes a nursing‑home type patient when the provision of acute care ends and the patient is then provided with accommodation and nursing care as an end in itself, whether at the first hospital or another hospital.","sortOrder":41},{"sectionNumber":"5. Ceasing and resuming hospital treatme","sectionType":"division","heading":"5. Ceasing and resuming hospital treatment","content":"### 5. Ceasing and resuming hospital treatment\n\nIf a nursing‑home type patient, or a person referred to in paragraph 4(a), leaves hospital but returns to a hospital, whether or not at the same hospital, not more than 7 days later and is provided with hospital treatment at the hospital, the patient is a nursing‑home type patient for each subsequent day that the patient is provided with accommodation and nursing care, as an end in itself, until the patient ceases to be provided with hospital treatment at a hospital for a period of more than 7 days.\n\nNote: If the relevant period of hospitalisation is broken by more than 7 days, clause 2 of this Schedule may again apply to the person.","sortOrder":42},{"sectionNumber":"6. Minimum benefit","sectionType":"division","heading":"6. Minimum benefit","content":"### 6. Minimum benefit\n\nThe minimum benefit for hospital treatment provided in the circumstances described in this Schedule is the amount set out in Table 1 or 2 of this Schedule for that hospital treatment.","sortOrder":43},{"sectionNumber":"Table 1","sectionType":"subdivision","heading":"Table 1","content":"#### Table 1\n\n| Public hospital: State/Territory | Minimum benefit per night |\n| -------------------------------- | ------------------------- |\n| Australian Capital Territory | $152.25 |\n| New South Wales | $190.30 |\n| Northern Territory | $162.75 |\n| Queensland | $150.75 |\n| South Australia | $150.00 |\n| Tasmania | $194.27 |\n| Victoria | $166.72 |\n| Western Australia | $155.15 |","sortOrder":44},{"sectionNumber":"Table 2","sectionType":"subdivision","heading":"Table 2","content":"#### Table 2\n\n| Private hospitals | $30.15 |\n| ----------------- | ------ |","sortOrder":45},{"sectionNumber":"Schedule 5―Second‑tier default benefits","sectionType":"part","heading":"Schedule 5―Second‑tier default benefits","content":"# Schedule 5―Second‑tier default benefits\n\n### 1. Interpretation\n\n(1) In this Schedule:\n\nauthorised officer means a departmental officer authorised by the Secretary of the Department to make a determination under subclause 1A (2), (3) or (4) or to review a determination under subclause 1B(3).\n\ncomparable has the meaning given by subclause 1A(6).\n\nHospital Casemix Protocol Data has the meaning given by rule 4 of the Private Health Insurance (Health Insurance Business) Rules 2018.\n\nsecond‑tier eligible hospital means a hospital in the class set out in rule 7A of the Private Health Insurance (Health Insurance Business) Rules 2018.\n\n(2) In this Schedule, except in subclauses 1A(8) and (9), the Australian Capital Territory is taken to be part of New South Wales, and the Northern Territory is taken to be part of South Australia.\n\n### 1A. Categorisation of private hospitals\n\n(1) If, as at 1 January 2019, a departmental officer authorised by the Secretary of the Department for the purpose has, in anticipation of the commencement of this provision, caused to be published on the Department’s website a list of all the hospitals for which a declaration is in force under subsection 121‑5(6) of the Act that places each hospital in a category set out in subclause (7), then each hospital is taken to be determined to be in that category.\n\n(2) If such a list has not been published, then as soon as practicable an authorised officer must determine which category of hospital from the categories set out in subclause (7) each private hospital for which a declaration is in force under subsection 121‑5(6) of the Act is to be placed in, and cause a list of the hospitals in each category to be published on the Department’s website.\n\nNote: If a patient is admitted to a hospital between 1 January 2019 and 31 August 2019 insurers may continue to work out the average charge on the basis of the provisions of this Schedule as in force immediately before the commencement of Schedule 4 to the Private Health Insurance (Reforms) Amendment Rules 2018. However, insurers must use the Department’s published list of hospitals under subclause (1) or (2) to determine in which category a hospital claiming second‑tier default benefits is placed.\n\n(3) If a private hospital is declared under subsection 121‑5(6) of the Act after 1 January 2019, an authorised officer must determine which category of hospital from the categories set out in subclause (7) that private hospital is to be placed in.\n\n(4) If a hospital has been placed in a category by a determination under this clause, an authorised officer may before 1 June of a particular year determine a different category of hospital from the categories set out in subclause (7) that the private hospital is to be placed in.\n\n(5) A list of the hospitals in each category as of 1 August of each year must be published on the Department’s website.\n\n(6) Private hospitals are comparable if they are placed in the same category by a determination made under subclause (1), (2), (3) or (4).\n\n(7) For the purposes of this clause, the categories are the following:\n\n(a) private hospitals that provide psychiatric care, including treatment of addictions, for at least 50% of the episodes of hospital treatment, and do not fall into category (g);\n\n(b) private hospitals that provide rehabilitation care for at least 50% of the episodes of hospital treatment, and do not fall into categories (a) or (g);\n\n(c) private hospitals that do not fall into categories (a), (b) or (g), with up to and including 50 licensed beds;\n\n(d) private hospitals that do not fall into categories (a), (b) or (g), with more than 50 licensed beds and up to and including 100 licensed beds;\n\n(e) private hospitals that do not fall into categories (a), (b) or (g), with more than 100 licensed beds, without an accident and emergency unit or a specialised cardiac care unit or an intensive care unit;\n\n(f) private hospitals that do not fall into categories (a), (b) or (g), with more than 100 licensed beds, with either (or any combination of) an accident and emergency unit or a specialised cardiac care unit or an intensive care unit;\n\n(g) private hospitals that provide episodes of hospital treatment only for periods of not more than 24 hours.\n\n(8) If State or Territory legislation in the State or Territory where the private hospital is located regulates the number of beds or patients that a private hospital is permitted—in subclause (7), a reference to licensed beds is a reference to the beds or patients that a private hospital is permitted, under State or Territory legislation in the State or Territory where the private hospital is located.\n\n(9) If State or Territory legislation in the State or Territory where the private hospital is located does not regulate the number of beds or patients that a private hospital is permitted—in subclause (7), a reference to licensed beds is a reference to the beds and bed equivalents the private hospital operates.\n\n(10) An authorised officer must calculate proportions for the purposes of paragraphs (7)(a) and (b):\n\n(a) if Hospital Casemix Protocol Data is available for the private hospital—using the most recent year of Hospital Casemix Protocol Data available to the Department for the private hospital; and\n\n(b) otherwise—on the basis of any relevant information available to the Department about the episodes of hospital treatment at the private hospital.\n\n### 1B. Internal review of a categorisation determination\n\n(1) A private hospital subject to a determination made under subclause 1A(1), (2), (3) or (4) may request internal review of its categorisation by the determination.\n\n(2) An application for internal review under subclause (1) must be made in writing within 28 days after the day the determination is notified to the hospital.\n\n(3) If an application for internal review is made, an authorised officer (who must not be the authorised officer who made the original determination) must:\n\n(a) review the determination; and\n\n(b) either confirm the determination or make a fresh one within 28 days after the day on which the application was received by the Department.\n\n### 2. Circumstances\n\nFor rules 4 and 5 of Part 2 of these Rules, the circumstances for hospital treatment to which this Schedule applies are that the treatment is provided to a patient who is not a nursing‑home type patient and the treatment is provided at a second‑tier eligible hospital.\n\nNote: The definition of hospital treatment in section 121‑5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121‑5(1)(c) of the Act.\n\n### 3. Minimum benefit\n\n(1) Despite anything in Schedules 1, 2 or 3, but subject to subclause (2) of this clause, the minimum benefit for hospital treatment provided in the circumstances described in clause 2 of this Schedule is the amount worked out in accordance with this clause.\n\n(2) Where hospital treatment is provided in the circumstances described in clause 2 of this Schedule, but:\n\n(a) the minimum benefit worked out in accordance with this clause for the hospital treatment is below the amount determined in accordance with Schedules 1, 2 or 3 of these Rules; or\n\n(b) an amount for the hospital treatment cannot be worked out in accordance with this clause,\n\nthe minimum benefit for that hospital treatment is the amount worked out in accordance with Schedules 1, 2 or 3 for that hospital treatment.\n\n(3) If a hospital ceases to be a second‑tier eligible hospital for the purposes of this Schedule, the minimum benefit in relation to an episode of hospital treatment for an insured person who was an admitted patient at the hospital or booked for hospital treatment at the hospital (as opposed to merely being on the hospital’s waiting list) before the day that the hospital ceased to be a second‑tier eligible hospital is the minimum benefit that would have applied if the hospital continued to be a second‑tier eligible hospital at the time the treatment was provided.\n\n(4) Subject to subclauses (2) and (8), the minimum benefit payable by an insurer for an episode of hospital treatment at a second‑tier eligible hospital for which the admission date was between 1 September of a particular year (the first year) and 31 August of the next year is an amount no less than 85% of the average charge for the equivalent episode of hospital treatment, under that insurer’s negotiated agreements as in force on 1 August of the first year, with all private hospitals:\n\n(a) that:\n\n(i) if the second‑tier eligible hospital is on the list published on the Department’s website under subclause 1A(5)—were comparable on 1 August of the first year with the second‑tier eligible hospital; and\n\n(ii) otherwise—are in the same category as the second‑tier eligible hospital in the list published on the Department’s website under subclause 1A(5) as at 1 August of the first year; and\n\n(b) that are in the same State as the second‑tier eligible hospital.\n\nNote: See clause 4 for a transitional arrangement for admissions to second‑tier eligible hospitals between 1 January 2019 and 31 August 2019.\n\n(5) The formula for calculating the average charge for the equivalent episode of hospital treatment by an insurer in each State is as follows:\n\n![A formula to work out the average charge for the equivalent episode of hospital treatment by an insurer in each State](image.002.png)\n\nWhere: j = group of equivalent episodes of hospital treatment under the insurer's negotiated agreements;\n\ni = group of the insurer's negotiated agreements in force on 1 August of the first year with comparable private hospitals in the State;\n\nn= the number of the insurer's negotiated agreements in force on 1 August of the first year with comparable private hospitals in the State;\n\nRji = charge for episode of hospital treatment type j in the negotiated agreement i\n\nRj = average charge for episode of hospital treatment type j.\n\n(6) In subclause (4), each episode of hospital treatment must be identified using the patient classification system and payment structure in the majority of the relevant insurer's negotiated agreements in force on 1 August of the first year with all comparable private hospitals in the State in which the second‑tier eligible hospital is located.\n\n(7) In subclause (4), for the purpose of calculating the average charge for the equivalent episode of hospital treatment in a State:\n\n(a) the charge will include the sum of the amount payable by the insurer under that insurer's negotiated agreement and any excess or co‑payment amounts payable by members, in accordance with the insurer's rules; and\n\nNote: Policy holders’ financial obligations under such levels of cover will still apply.\n\n(b) must not include any charges:\n\n(i) referred to in the insurer's negotiated agreements for medical devices and human tissue products; and\n\n(ii) that are minimum benefits for medical devices and human tissue products as specified for the purpose of item 4 of the table in subsection 72‑1(2) of the Act, and\n\n(iii) referred to in the insurer's negotiated agreements for hospital treatment provided to nursing‑home type patients.\n\n(8) Subject to subclause (2), if an insurer has less than 5 negotiated agreements in force on 1 August of the first year with a particular category of comparable private hospitals in a State, then all of that insurer's negotiated agreements with all classes of private hospitals in that State are to be used to calculate the minimum benefit.\n\n### 4. Transitional\n\n(1) If a patient is admitted to a second‑tier eligible hospital between 1 January 2019 and 31 August 2019:\n\n(a) an insurer may instead work out the average charge on the basis of the repealed provisions; and\n\n(b) if the insurer does so, comparable has the same meaning as in the repealed provisions.\n\n(2) For subclause (1), the repealed provisions are the provisions of this Schedule as in force immediately before the commencement of Schedule 4 to the Private Health Insurance (Reforms) Amendment Rules 2018.\n\nNote: For the purpose of determining which category the second‑tier eligible hospital to which the patient was admitted is placed in, an insurer must use the Department’s determination in respect of that hospital under subclause 1A(1), (2), (3) or (4).","sortOrder":46},{"sectionNumber":"1. Interpretation","sectionType":"division","heading":"1. Interpretation","content":"### 1. Interpretation\n\n(1) In this Schedule:\n\nauthorised officer means a departmental officer authorised by the Secretary of the Department to make a determination under subclause 1A (2), (3) or (4) or to review a determination under subclause 1B(3).\n\ncomparable has the meaning given by subclause 1A(6).\n\nHospital Casemix Protocol Data has the meaning given by rule 4 of the Private Health Insurance (Health Insurance Business) Rules 2018.\n\nsecond‑tier eligible hospital means a hospital in the class set out in rule 7A of the Private Health Insurance (Health Insurance Business) Rules 2018.\n\n(2) In this Schedule, except in subclauses 1A(8) and (9), the Australian Capital Territory is taken to be part of New South Wales, and the Northern Territory is taken to be part of South Australia.","sortOrder":47},{"sectionNumber":"1A. Categorisation of private hospitals","sectionType":"division","heading":"1A. Categorisation of private hospitals","content":"### 1A. Categorisation of private hospitals\n\n(1) If, as at 1 January 2019, a departmental officer authorised by the Secretary of the Department for the purpose has, in anticipation of the commencement of this provision, caused to be published on the Department’s website a list of all the hospitals for which a declaration is in force under subsection 121‑5(6) of the Act that places each hospital in a category set out in subclause (7), then each hospital is taken to be determined to be in that category.\n\n(2) If such a list has not been published, then as soon as practicable an authorised officer must determine which category of hospital from the categories set out in subclause (7) each private hospital for which a declaration is in force under subsection 121‑5(6) of the Act is to be placed in, and cause a list of the hospitals in each category to be published on the Department’s website.\n\nNote: If a patient is admitted to a hospital between 1 January 2019 and 31 August 2019 insurers may continue to work out the average charge on the basis of the provisions of this Schedule as in force immediately before the commencement of Schedule 4 to the Private Health Insurance (Reforms) Amendment Rules 2018. However, insurers must use the Department’s published list of hospitals under subclause (1) or (2) to determine in which category a hospital claiming second‑tier default benefits is placed.\n\n(3) If a private hospital is declared under subsection 121‑5(6) of the Act after 1 January 2019, an authorised officer must determine which category of hospital from the categories set out in subclause (7) that private hospital is to be placed in.\n\n(4) If a hospital has been placed in a category by a determination under this clause, an authorised officer may before 1 June of a particular year determine a different category of hospital from the categories set out in subclause (7) that the private hospital is to be placed in.\n\n(5) A list of the hospitals in each category as of 1 August of each year must be published on the Department’s website.\n\n(6) Private hospitals are comparable if they are placed in the same category by a determination made under subclause (1), (2), (3) or (4).\n\n(7) For the purposes of this clause, the categories are the following:\n\n(a) private hospitals that provide psychiatric care, including treatment of addictions, for at least 50% of the episodes of hospital treatment, and do not fall into category (g);\n\n(b) private hospitals that provide rehabilitation care for at least 50% of the episodes of hospital treatment, and do not fall into categories (a) or (g);\n\n(c) private hospitals that do not fall into categories (a), (b) or (g), with up to and including 50 licensed beds;\n\n(d) private hospitals that do not fall into categories (a), (b) or (g), with more than 50 licensed beds and up to and including 100 licensed beds;\n\n(e) private hospitals that do not fall into categories (a), (b) or (g), with more than 100 licensed beds, without an accident and emergency unit or a specialised cardiac care unit or an intensive care unit;\n\n(f) private hospitals that do not fall into categories (a), (b) or (g), with more than 100 licensed beds, with either (or any combination of) an accident and emergency unit or a specialised cardiac care unit or an intensive care unit;\n\n(g) private hospitals that provide episodes of hospital treatment only for periods of not more than 24 hours.\n\n(8) If State or Territory legislation in the State or Territory where the private hospital is located regulates the number of beds or patients that a private hospital is permitted—in subclause (7), a reference to licensed beds is a reference to the beds or patients that a private hospital is permitted, under State or Territory legislation in the State or Territory where the private hospital is located.\n\n(9) If State or Territory legislation in the State or Territory where the private hospital is located does not regulate the number of beds or patients that a private hospital is permitted—in subclause (7), a reference to licensed beds is a reference to the beds and bed equivalents the private hospital operates.\n\n(10) An authorised officer must calculate proportions for the purposes of paragraphs (7)(a) and (b):\n\n(a) if Hospital Casemix Protocol Data is available for the private hospital—using the most recent year of Hospital Casemix Protocol Data available to the Department for the private hospital; and\n\n(b) otherwise—on the basis of any relevant information available to the Department about the episodes of hospital treatment at the private hospital.","sortOrder":48},{"sectionNumber":"1B. Internal review of a categorisation ","sectionType":"division","heading":"1B. Internal review of a categorisation determination","content":"### 1B. Internal review of a categorisation determination\n\n(1) A private hospital subject to a determination made under subclause 1A(1), (2), (3) or (4) may request internal review of its categorisation by the determination.\n\n(2) An application for internal review under subclause (1) must be made in writing within 28 days after the day the determination is notified to the hospital.\n\n(3) If an application for internal review is made, an authorised officer (who must not be the authorised officer who made the original determination) must:\n\n(a) review the determination; and\n\n(b) either confirm the determination or make a fresh one within 28 days after the day on which the application was received by the Department.","sortOrder":49},{"sectionNumber":"2. Circumstances","sectionType":"division","heading":"2. Circumstances","content":"### 2. Circumstances\n\nFor rules 4 and 5 of Part 2 of these Rules, the circumstances for hospital treatment to which this Schedule applies are that the treatment is provided to a patient who is not a nursing‑home type patient and the treatment is provided at a second‑tier eligible hospital.\n\nNote: The definition of hospital treatment in section 121‑5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121‑5(1)(c) of the Act.","sortOrder":50},{"sectionNumber":"3. Minimum benefit","sectionType":"division","heading":"3. Minimum benefit","content":"### 3. Minimum benefit\n\n(1) Despite anything in Schedules 1, 2 or 3, but subject to subclause (2) of this clause, the minimum benefit for hospital treatment provided in the circumstances described in clause 2 of this Schedule is the amount worked out in accordance with this clause.\n\n(2) Where hospital treatment is provided in the circumstances described in clause 2 of this Schedule, but:\n\n(a) the minimum benefit worked out in accordance with this clause for the hospital treatment is below the amount determined in accordance with Schedules 1, 2 or 3 of these Rules; or\n\n(b) an amount for the hospital treatment cannot be worked out in accordance with this clause,\n\nthe minimum benefit for that hospital treatment is the amount worked out in accordance with Schedules 1, 2 or 3 for that hospital treatment.\n\n(3) If a hospital ceases to be a second‑tier eligible hospital for the purposes of this Schedule, the minimum benefit in relation to an episode of hospital treatment for an insured person who was an admitted patient at the hospital or booked for hospital treatment at the hospital (as opposed to merely being on the hospital’s waiting list) before the day that the hospital ceased to be a second‑tier eligible hospital is the minimum benefit that would have applied if the hospital continued to be a second‑tier eligible hospital at the time the treatment was provided.\n\n(4) Subject to subclauses (2) and (8), the minimum benefit payable by an insurer for an episode of hospital treatment at a second‑tier eligible hospital for which the admission date was between 1 September of a particular year (the first year) and 31 August of the next year is an amount no less than 85% of the average charge for the equivalent episode of hospital treatment, under that insurer’s negotiated agreements as in force on 1 August of the first year, with all private hospitals:\n\n(a) that:\n\n(i) if the second‑tier eligible hospital is on the list published on the Department’s website under subclause 1A(5)—were comparable on 1 August of the first year with the second‑tier eligible hospital; and\n\n(ii) otherwise—are in the same category as the second‑tier eligible hospital in the list published on the Department’s website under subclause 1A(5) as at 1 August of the first year; and\n\n(b) that are in the same State as the second‑tier eligible hospital.\n\nNote: See clause 4 for a transitional arrangement for admissions to second‑tier eligible hospitals between 1 January 2019 and 31 August 2019.\n\n(5) The formula for calculating the average charge for the equivalent episode of hospital treatment by an insurer in each State is as follows:\n\n![A formula to work out the average charge for the equivalent episode of hospital treatment by an insurer in each State](image.002.png)\n\nWhere: j = group of equivalent episodes of hospital treatment under the insurer's negotiated agreements;\n\ni = group of the insurer's negotiated agreements in force on 1 August of the first year with comparable private hospitals in the State;\n\nn= the number of the insurer's negotiated agreements in force on 1 August of the first year with comparable private hospitals in the State;\n\nRji = charge for episode of hospital treatment type j in the negotiated agreement i\n\nRj = average charge for episode of hospital treatment type j.\n\n(6) In subclause (4), each episode of hospital treatment must be identified using the patient classification system and payment structure in the majority of the relevant insurer's negotiated agreements in force on 1 August of the first year with all comparable private hospitals in the State in which the second‑tier eligible hospital is located.\n\n(7) In subclause (4), for the purpose of calculating the average charge for the equivalent episode of hospital treatment in a State:\n\n(a) the charge will include the sum of the amount payable by the insurer under that insurer's negotiated agreement and any excess or co‑payment amounts payable by members, in accordance with the insurer's rules; and\n\nNote: Policy holders’ financial obligations under such levels of cover will still apply.\n\n(b) must not include any charges:\n\n(i) referred to in the insurer's negotiated agreements for medical devices and human tissue products; and\n\n(ii) that are minimum benefits for medical devices and human tissue products as specified for the purpose of item 4 of the table in subsection 72‑1(2) of the Act, and\n\n(iii) referred to in the insurer's negotiated agreements for hospital treatment provided to nursing‑home type patients.\n\n(8) Subject to subclause (2), if an insurer has less than 5 negotiated agreements in force on 1 August of the first year with a particular category of comparable private hospitals in a State, then all of that insurer's negotiated agreements with all classes of private hospitals in that State are to be used to calculate the minimum benefit.","sortOrder":51},{"sectionNumber":"4. Transitional","sectionType":"division","heading":"4. Transitional","content":"### 4. Transitional\n\n(1) If a patient is admitted to a second‑tier eligible hospital between 1 January 2019 and 31 August 2019:\n\n(a) an insurer may instead work out the average charge on the basis of the repealed provisions; and\n\n(b) if the insurer does so, comparable has the same meaning as in the repealed provisions.\n\n(2) For subclause (1), the repealed provisions are the provisions of this Schedule as in force immediately before the commencement of Schedule 4 to the Private Health Insurance (Reforms) Amendment Rules 2018.\n\nNote: For the purpose of determining which category the second‑tier eligible hospital to which the patient was admitted is placed in, an insurer must use the Department’s determination in respect of that hospital under subclause 1A(1), (2), (3) or (4).","sortOrder":52}],"analysis":{"flash_summary":{"complexity_score":9,"scope_assessment":{"changed":true,"description":"The original rules set simple minimum benefits for overnight and same-day hospital stays. Over time, they have been significantly expanded, notably through the 2018 reforms that introduced a detailed hospital categorisation system (based on bed numbers, services, and specialty focus) and a complex second-tier default benefit calculation. This has increased the scope from a straightforward payment schedule to a heavily conditional framework involving administrative determinations and market-based averages."},"complexity_factors":["Over 30 defined terms, many referencing other acts (e.g., Health Insurance Act 1973).","Multiple schedules with different conditions (overnight, same-day, nursing-home, second-tier).","Cross-references to other rules (e.g., Private Health Insurance (Health Insurance Business) Rules 2018).","Conditional logic for certification of Type B and C procedures as overnight stays.","Tables with dollar amounts varying by state, patient category, and length of stay.","Complex formula for second-tier default benefits involving averages and multiple conditions.","Transitional provisions and internal review mechanisms for hospital categorisation."],"plain_english_summary":"This law sets the minimum amounts private health insurers must pay for hospital treatment under a health insurance policy. It covers different situations:\n\n- **Overnight stays** at private hospitals or shared wards in public hospitals (in Victoria and Tasmania): Payments vary by patient type (e.g., advanced surgical, psychiatric, rehabilitation) and length of stay. For example, an advanced surgical patient gets $540 per night for the first 14 days, then $376.\n- **Overnight shared ward** in public hospitals in other states: A flat rate per night (e.g., $446 in NSW, $458 in Queensland).\n- **Same-day procedures**: Payments depend on whether it's a public or private hospital and the 'band' of the procedure (based on anaesthetic type and theatre time). Ranges from $281 to $501.\n- **Nursing-home type patients** (long stays over 35 days): Lower rates, e.g., $30.15 per night at private hospitals, varying by state at public hospitals.\n- **Second-tier default benefits**: For hospitals without a contract with the insurer, the minimum benefit is at least 85% of the average charge from similar hospitals under the insurer's contracts, calculated using a complex formula.\n\nInsurers cannot pay more than the hospital's fees. People with insurance can still have co-payments or excess deducted.\n\nThe rules apply to psychiatric, rehabilitation, and palliative care, as well as other hospital treatments."},"summary":{"name":"Private Health Insurance (Benefit Requirements) Rules 2011","slug":"private-health-insurance-benefit-requirements-rules-2011","title_id":"F2011L02160","version_id":87597,"analysis_type":"summary","content_quality":"ok","complexity_score":4,"scope_assessment":{"changed":false,"description":"Whole instrument, in force. Two-pass analysis applied due to size."},"complexity_factors":["554,684 chars, almost entirely Schedule tables with procedure-specific minimum benefit calculations","Multiple procedure classification systems (Type A, B, C) with different benefit regimes","State and territory-specific variations within each Schedule","Interaction with Medicare Benefits Schedule and Health Insurance Act 1973 fee definitions","Complex negotiated agreement override mechanism"],"plain_english_summary":"The Private Health Insurance (Benefit Requirements) Rules 2011 (Cth) set out the minimum benefit amounts that private health insurers must pay to fund holders for hospital treatment covered by their policies. The Rules are made under the Private Health Insurance Act 2007 (Cth) and implement the statutory minimum benefit obligations in subsection 72-1(2) of that Act.\n\nThe operative provisions in Part 2 establish two main minimum benefit categories. Rule 4 covers hospital treatment that is psychiatric care, rehabilitation, or palliative care. Rule 5 covers all other types of hospital treatment. For both categories, the minimum benefit payable is determined by reference to the relevant Schedule, taking into account the type of procedure, the type of accommodation (private hospital, shared ward in a public hospital, or other public hospital), and whether a negotiated agreement exists between the insurer and the hospital. Rule 6 provides that benefits cannot exceed the actual fees or charges incurred.\n\nThe Schedules are the operational heart of the instrument. They are organised primarily by procedure type (Type A, Type B, and Type C procedures) and by accommodation type and state or territory. Schedule 1 covers overnight accommodation in private hospitals and shared ward accommodation in public hospitals in Victoria and Tasmania. Schedules 2 and 3 cover other public hospital situations and day surgery procedures. Schedule 4 covers nursing-home type patients. Schedule 5 addresses outreach services and services provided by midwives and nurse practitioners.\n\nThe instrument has been the subject of Federal Court litigation concerning the scope of 'hospital treatment' for psychiatric services and the application of minimum benefit obligations to disputed admissions."},"kimi_summary":{"_metrics":{"completionTokens":703},"content_quality":"ok","complexity_score":8,"scope_assessment":{"changed":false,"description":"The legislation appears to be operating within its original scope as a technical instrument setting minimum benefit requirements for private health insurance hospital cover. No evidence of scope creep beyond the original purpose of establishing baseline payment obligations for insurers."},"complexity_factors":["Multiple nested definitions (Type A includes certified Type B, which includes certified Type C)","Extensive cross-referencing to Medicare Benefits Schedule (MBS) item numbers (hundreds of specific item codes)","State/territory-specific rate tables with different amounts for each jurisdiction","Tiered benefit structures based on length of stay (e.g., first 14 days vs over 14 days vs over 65 days)","Dual certification requirements for Type C procedures (must satisfy both Schedule 1 clause 11 and Schedule 3 clause 7)","Conditional logic for patient classification (advanced surgical vs surgical vs obstetric vs psychiatric vs rehabilitation vs other)","Complex interaction between negotiated agreements and minimum benefit requirements","Multiple schedules with overlapping but distinct coverage (Schedules 1-5 referenced but not all shown)","Transitional provisions and references to repealed/amended legislation in notes"],"plain_english_summary":"This legislation sets the **minimum amounts that private health insurers must pay** for hospital accommodation and treatment in Australia. It ensures that when you make a claim, your insurer covers at least a baseline amount.\n\n**Who it affects:**\n- **Private health insurance members** – anyone with hospital cover\n- **Private health insurers** – they must pay at least these minimum amounts\n- **Hospitals** – both private and public hospitals that treat private patients\n\n**What it covers:**\n\nThe Rules divide hospital treatment into different **\"types\" of procedures** (A, B, and C) based on complexity and whether an overnight stay is needed:\n\n- **Type A procedures** – complex procedures requiring overnight stays (major surgery, childbirth, etc.)\n- **Type B procedures** – day procedures not requiring overnight stays (minor surgery, endoscopies, etc.)\n- **Type C procedures** – procedures that normally don't need hospital care at all, but can be covered if a doctor certifies it's medically necessary\n\n**Key features:**\n\n- **Overnight accommodation** – sets dollar amounts per night based on patient type (advanced surgical, surgical/obstetric, psychiatric, rehabilitation, or other patients) and length of stay. For example, advanced surgical patients get $540/night for the first 14 days, dropping to $376/night after that.\n\n- **Same-day procedures** – uses a \"band\" system (Bands 1-4) based on anaesthetic type and theatre time, with different rates for public vs private hospitals and by state/territory.\n\n- **Certification requirements** – for some procedures (Type B and C), doctors must certify in writing that hospital treatment is medically necessary.\n\n- **Negotiated agreements** – insurers can pay different amounts if they have a specific agreement with a hospital.\n\n- **Co-payments and excesses** – insurers can reduce the minimum benefit by any excess or co-payment in your policy.\n\nThe Rules also prevent insurers from paying more than the actual hospital fees charged, and include special provisions for \"nursing-home type patients\" (long-stay patients in hospital)."}},"importantCases":[],"_links":{"self":"/api/acts/private-health-insurance-benefit-requirements-rules-2011","history":"/api/acts/private-health-insurance-benefit-requirements-rules-2011/history","analysis":"/api/acts/private-health-insurance-benefit-requirements-rules-2011/analysis","conflicts":"/api/acts/private-health-insurance-benefit-requirements-rules-2011/conflicts","importantCases":"/api/acts/private-health-insurance-benefit-requirements-rules-2011/important-cases","documents":"/api/acts/private-health-insurance-benefit-requirements-rules-2011/documents"}}